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General NPI Number Information
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NPI Number | 1831662311
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Entity Type | Organization
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Legal Business Name | CACHE VALLEY VEIN
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 565 W 465 N STE 130
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City | PROVIDENCE
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State | UT
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Zip | 84332-4802
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Country | US
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Telephone | 435-753-2842
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3155
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City | IDAHO FALLS
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State | ID
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Zip | 83403-3155
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Country | US
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Telephone | 208-552-8579
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Fax | 208-523-2025
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN J STROBEL
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Credential | MD
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Telephone | 208-542-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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