MEDICARE: PUBLIC HEALTH DISTRICT 1

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	251K00000X	Public Health or Welfare Agency		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	DH124	OTHER	ID	BLUE CROSS OF IDAHO
3	DH132	OTHER	ID	BLUE CROSS OF IDAHO
4	000010023565	OTHER	DE	REGENCE BLUE SHIELD OF ID
5	000010024099	OTHER	DE	REGENCE BLUE SHIELD OF ID
6	000010008200	OTHER	ID	REGENCE BLUE SHIELD OF ID
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	DH0017	OTHER	ID	BLUE CROSS OF IDAHO
9	DJ780	OTHER	ID	BLUE CROSS OF IDAHO
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	000010018276	OTHER	ID	REGENCE BLUE SHIELD OF ID
12	DH116	OTHER	ID	BLUE CROSS OF IDAHO
13	000010021347	OTHER	ID	REGENCE BLUE SHIELD OF ID
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841212933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIC HEALTH DISTRICT 1

Provider Business Mailing Address
First Line	:	8500 N ATLAS ROAD
Second Line	:
City	:	HAYDEN
State	:	ID
Zip	:	83835-7677
Country	:	US
Telephone Number	:	208-786-7474
Fax Number	:	208-786-7109

Provider Business Practice Location Address
First Line	:	8500 N ATLAS RD
Second Line	:
City	:	HAYDEN
State	:	ID
Zip	:	83835-8332
Country	:	US
Telephone Number	:	208-415-5100
Fax Number	:	208-415-5161

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. DONALD DUFFY
Credential	:
Telephone Number	:	208-415-5163

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	03/16/2022

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Directions to “PUBLIC HEALTH DISTRICT 1 ” Practice Location

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