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General NPI Number Information
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NPI Number | 1154954683
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Entity Type | Organization
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Legal Business Name | ADVANCED CLINICAL TRAUMA SERVICES
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 2950 E MAGIC VIEW DR STE 192
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-600-2184
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Fax | 833-258-9488
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Provider Business Mailing Address
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Address Line | 2950 E MAGIC VIEW DR STE 192
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-600-2184
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Fax | 833-258-9488
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JEWELYA K STEPHENS
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Credential |
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Telephone | 208-600-2184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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