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General NPI Number Information
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NPI Number | 1942813134
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Entity Type | Organization
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Legal Business Name | PHOENIX HEALTH LLC
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Dates
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Enumeration Date | 08/26/2020
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Last Update Date | 08/26/2020
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Provider Practice Location Address
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Address Line | 3142 W BELLTOWER DR
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City | MERIDIAN
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State | ID
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Zip | 83646-4882
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Country | US
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Telephone | 208-996-0099
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Fax |
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Provider Business Mailing Address
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Address Line | 3142 W BELLTOWER DR
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City | MERIDIAN
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State | ID
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Zip | 83646-4882
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Country | US
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Telephone | 208-996-0099
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | KATIE JONES
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Credential | RN
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Telephone | 208-996-0099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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