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General NPI Number Information
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NPI Number | 1972900546
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Entity Type | Organization
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Legal Business Name | LEWIS-CLARK STATE COLLEGE
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Dates
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Enumeration Date | 11/26/2014
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Last Update Date | 11/26/2014
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Provider Practice Location Address
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Address Line | 500 8TH AVE SAM GLENN COMPLEX 205
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City | LEWISTON
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State | ID
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Zip | 83501-2691
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Country | US
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Telephone | 208-792-2251
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Fax | 208-792-2882
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Provider Business Mailing Address
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Address Line | 500 8TH AVE SAM GLENN COMPLEX 205
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City | LEWISTON
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State | ID
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Zip | 83501-2691
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Country | US
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Telephone | 208-792-2251
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Fax | 208-792-2882
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Authorized Official
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Title or Position | VP FOR FINANCE AND ADMINISTRATION
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Name | MR. CHET HERBST
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Credential |
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Telephone | 208-792-2240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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