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General NPI Number Information
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NPI Number | 1194117366
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Entity Type | Organization
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Legal Business Name | WESTFALL VENTURES, INC
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 2572 N. STOKESBERRY PL
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City | MERIDIAN
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State | ID
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Zip | 83646
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Country | US
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Telephone | 208-440-2782
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Fax |
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Provider Business Mailing Address
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Address Line | 2572 N STOKESBERRY PL STE 300
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City | MERIDIAN
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State | ID
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Zip | 83646-6070
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIMBERLY PLATTER
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Credential |
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Telephone | 208-440-2782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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