MEDICARE: WESTERN VISITING NURSES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HH-195	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558368233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN VISITING NURSES, INC.

Provider Business Mailing Address
First Line	:	1400 BENTON ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-4253
Country	:	US
Telephone Number	:	208-522-3291
Fax Number	:	208-529-3914

Provider Business Practice Location Address
First Line	:	1400 BENTON ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-4253
Country	:	US
Telephone Number	:	208-522-3291
Fax Number	:	208-529-3914

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DEXTRAL DALE MILES
Credential	:	MBA
Telephone Number	:	208-522-3291

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/06/2012

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