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General NPI Number Information
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NPI Number | 1467274944
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Entity Type | Organization
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Legal Business Name | SNAKE RIVER WOUND CARE AND HYPERBARICS LLC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 781 NORTH COLLEGE ROAD
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City | TWIN FALLS
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State | ID
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Zip | 83301
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Country | US
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Telephone | 210-255-7565
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Fax |
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Provider Business Mailing Address
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Address Line | 781 NORTH COLLEGE ROAD
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City | TWIN FALLS
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State | ID
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Zip | 83301
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Country | US
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Telephone | 210-255-7565
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUMEDHA MOHAN
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Credential |
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Telephone | 210-255-7565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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