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General NPI Number Information
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NPI Number | 1649649807
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Entity Type | Organization
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Legal Business Name | SOUTH HILL SUBOXONE
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 1103 E BEST AVE STE C
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4878
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Country | US
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Telephone | 866-805-0885
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3727
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City | COEUR D ALENE
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State | ID
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Zip | 83816-2529
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Country | US
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Telephone | 866-805-0885
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAMIL SIDHU
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Credential | MD
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Telephone | 866-805-0885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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