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General NPI Number Information
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NPI Number | 1831132232
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Entity Type | Individual
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Provider Name | TY A SALNESS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 845 W CENTER ST SUITE 200
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City | POCATELLO
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State | ID
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Zip | 83204-4205
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Country | US
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Telephone | 208-232-6260
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Fax | 208-232-6259
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Provider Business Mailing Address
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Address Line | PO BOX 2377
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City | POCATELLO
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State | ID
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Zip | 83206-2377
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Country | US
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Telephone | 208-232-7862
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Fax | 208-232-7869
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M9343
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | M9343
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License Number State | ID
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