MEDICARE: LIFE SPRING WOMENS CLINIC, P.A.

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	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010006530	OTHER	ID	BLUE SHIELD OF IDAHO
2	8994-6	OTHER	ID	BLUE CROSS OF IDAHO

General Provider Information

NPI Number	:	1992840326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SPRING WOMENS CLINIC, P.A.

Provider Business Mailing Address
First Line	:	1660 JOHN ADAMS PKWY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-4360
Country	:	US
Telephone Number	:	208-523-8844
Fax Number	:	208-529-8684

Provider Business Practice Location Address
First Line	:	1660 JOHN ADAMS PKWY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-4360
Country	:	US
Telephone Number	:	208-523-8844
Fax Number	:	208-529-8684

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CRAIG ZANE HALL
Credential	:	M.D.
Telephone Number	:	208-523-8844

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	03/28/2008

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Directions to “LIFE SPRING WOMENS CLINIC, P.A. ” Practice Location

Language	Start Address	Practice Location

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