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General NPI Number Information
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NPI Number | 1285794339
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Entity Type | Organization
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Legal Business Name | SOUTH CENTRAL PUBLIC HEALTH DISTRICT
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 1020 WASHINGTON ST N
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City | TWIN FALLS
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State | ID
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Zip | 83301-3156
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Country | US
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Telephone | 208-734-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 WASHINGTON ST N
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City | TWIN FALLS
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State | ID
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Zip | 83301-3156
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Country | US
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Telephone | 208-734-5900
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Fax |
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Authorized Official
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Title or Position | DISTRICT DIRECTOR
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Name | MR. RENE LEBLANC
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Credential |
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Telephone | 208-737-5902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-1046
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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