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General NPI Number Information
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NPI Number | 1962268938
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Entity Type | Organization
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Legal Business Name | CENTRAL IDAHO INFUSION CENTER LLC
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 868 E MAIN ST
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City | JEROME
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State | ID
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Zip | 83338-2446
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Country | US
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Telephone | 208-316-6424
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 8TH AVE E
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City | JEROME
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State | ID
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Zip | 83338-2139
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Country | US
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Telephone | 208-316-6424
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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 | JOLYNE DICKINSON
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Credential | RN
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Telephone | 208-316-6424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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