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General NPI Number Information
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NPI Number | 1336220243
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN DIABETES AND OSTEOPOROSIS CENTER PA
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/27/2009
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Provider Practice Location Address
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Address Line | 3910 WASHINGTON PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7596
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Country | US
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Telephone | 208-522-2996
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Fax | 208-523-3318
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Provider Business Mailing Address
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Address Line | 3910 WASHINGTON PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7596
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Country | US
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Telephone | 208-522-2996
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Fax | 208-523-3318
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Authorized Official
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Title or Position | BILLING LEAD
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Name | JANET M HOOVER
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Credential |
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Telephone | 208-522-2996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | M4220
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | M9285
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | M7763
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License Number State | ID
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