MEDICARE: HEALTH WEST, 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	207Q00000X	Family Medicine Physician	M7806	ID
2	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	85910	OTHER	ID	BLUE CROSS OF IDAHO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588666945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH WEST, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2377
Second Line	:
City	:	POCATELLO
State	:	ID
Zip	:	83206-2377
Country	:	US
Telephone Number	:	208-232-7862
Fax Number	:	208-232-7869

Provider Business Practice Location Address
First Line	:	79 N MAIN ST
Second Line	:
City	:	DOWNEY
State	:	ID
Zip	:	83234
Country	:	US
Telephone Number	:	208-897-5600
Fax Number	:	208-897-5603

Authorized Official
Title or Position	:	CEO
Name	:	MINDY BENEDETTI
Credential	:
Telephone Number	:	208-232-7862

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	08/17/2020

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Directions to “HEALTH WEST, INC. ” Practice Location

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