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General NPI Number Information
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NPI Number | 1447811740
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Entity Type | Organization
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Legal Business Name | EAST IDAHO AUDIOLOGY LLC
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 527 RIGBY LAKE DR STE C
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City | RIGBY
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State | ID
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Zip | 83442-5117
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Country | US
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Telephone | 208-522-6335
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Fax | 208-522-0550
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Provider Business Mailing Address
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Address Line | 527 RIGBY LAKE DR STE C
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City | RIGBY
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State | ID
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Zip | 83442-5117
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Country | US
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Telephone | 208-522-6335
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Fax | 208-522-0550
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD LEE
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Credential | MD
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Telephone | 208-522-6335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355A2700X
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Taxonomy Name | Audiology Assistant
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License Number |
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License Number State |
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