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General NPI Number Information
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NPI Number | 1801989454
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Entity Type | Organization
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Legal Business Name | ARTHRITIS SPECIALTY CENTER,INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1448 E CENTER STREET SUITE E
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City | POCATELLO
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State | ID
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Zip | 83201
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Country | US
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Telephone | 208-234-1300
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Fax | 208-234-1333
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Provider Business Mailing Address
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Address Line | 1448 E CENTER STREET SUITE E
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City | POCATELLO
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State | ID
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Zip | 83201
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Country | US
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Telephone | 208-234-1300
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Fax | 208-234-1333
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANANDA WALALIYADDA
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Credential | MD
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Telephone | 208-234-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M8731
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License Number State | ID
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