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General NPI Number Information
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NPI Number | 1861864712
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Entity Type | Organization
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Legal Business Name | NOT-TSOO GAH-NEE INDIAN HEALTH CENTER
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 717 MISSION ROAD
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City | FORT HALL
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State | ID
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Zip | 83203-0717
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Country | US
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Telephone | 208-238-5400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 717
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City | FORT HALL
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State | ID
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Zip | 83203-0717
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHIRLEY ALVAREZ
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Credential |
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Telephone | 208-238-5493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | P5176
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License Number State | ID
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