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General NPI Number Information
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NPI Number | 1215977384
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Entity Type | Organization
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Legal Business Name | VALLEY MEDICAL SHOPPE INC
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 3908 WASHINGTON PARKWAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-523-3800
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Fax | 208-529-1817
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Provider Business Mailing Address
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Address Line | 146 N 2ND E
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City | REXBURG
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State | ID
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Zip | 83440-1620
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Country | US
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Telephone | 208-356-7913
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Fax | 208-356-9532
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Authorized Official
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Title or Position | OWNER
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Name | MR. GARY W AIMAN
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Credential |
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Telephone | 208-356-7913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | DME 225
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License Number State | ID
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