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General NPI Number Information
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NPI Number | 1548450034
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Entity Type | Organization
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Legal Business Name | BMH, INC.
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 1151 HOSPITAL WAY STE D
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City | POCATELLO
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State | ID
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Zip | 83201-5091
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Country | US
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Telephone | 208-233-1451
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Fax |
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Provider Business Mailing Address
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Address Line | 1151 HOSPITAL WAY STE D
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City | POCATELLO
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State | ID
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Zip | 83201-5091
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Country | US
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Telephone | 208-233-1451
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Fax |
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Authorized Official
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Title or Position | PSO SUPPORT SPECIALIST
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Name | LISA RUDOLPH
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Credential |
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Telephone | 208-782-3992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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