=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235232422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA L. BABBITT M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2006
-----------------------------------------------------
Last Update Date | 02/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 S 11TH AVE SUITE 203
-----------------------------------------------------
City | POCATELLO
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83201-4835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-232-5902
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4883
-----------------------------------------------------
City | POCATELLO
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83205-4883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-236-1600
-----------------------------------------------------
Fax | 208-236-6695
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | TL3384
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------