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General NPI Number Information
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NPI Number | 1295734796
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Entity Type | Organization
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Legal Business Name | HEALTH WEST, INC.
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 330 N MAIN
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City | ABERDEEN
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State | ID
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Zip | 83210-0419
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Country | US
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Telephone | 208-397-4126
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Fax | 208-397-4176
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Provider Business Mailing Address
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Address Line | PO BOX 2377
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City | POCATELLO
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State | ID
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Zip | 83206-2377
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Country | US
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Telephone | 208-232-7862
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Fax | 208-232-7869
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Authorized Official
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Title or Position | CEO
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Name | MINDY BENEDETTI
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Credential |
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Telephone | 208-232-7862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M7806
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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