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General NPI Number Information
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NPI Number | 1952438004
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Entity Type | Organization
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Legal Business Name | SILVER VALLEY MEDICINE INC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 107 CHURCH ST
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City | PINEHURST
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State | ID
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Zip | 83850-0945
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Country | US
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Telephone | 208-682-2151
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 945 107 CHURCH ST.
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City | PINEHURST
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State | ID
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Zip | 83850-0945
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Country | US
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Telephone | 208-682-2150
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | YANHUA GAO
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Credential |
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Telephone | 208-682-2151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0246
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License Number State | ID
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