institution
Mountain Health Mid Level
Medical Physician Assistant in Kellogg, Idaho
NPI 1700076510

Mountain Health Mid Level is a Medical Physician Assistant based in Kellogg, ID and is specialized in Medical. Mountain Health Mid Level practices in Kellogg, ID. The NPI Number for Mountain Health Mid Level is 1700076510 and holds a License No. PA28 (Idaho).

The current practice location address for Mountain Health Mid Level is 740 Mckinley Ave, Kellogg, ID and can be reached out via phone at 208-783-1267 and via fax at 208-786-4471.

Location: 740 Mckinley Ave, Kellogg, ID, 83837-2693
institution
Provider Profile Details
NPI Number
1700076510
Provider Name
Mountain Health Mid Level
Credential
Provider Entity Type
Organization
Address
740 Mckinley Ave, Kellogg, ID, 83837-2693
Phone Number
208-783-1267
Fax Number
208-786-4471
Provider Enumeration Date
07/27/2007
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
002791000 05 ID
CC9834 01 ID RAILROAD MEDICARE
8A570 01 ID BLUE CROSS
000010006537 01 ID REGENCE
institution
Provider Business Practice Location Address Details
Address
740 Mckinley Ave
City
State
Zip
83837-2693
Phone Number
208-783-1267
Fax Number
208-786-4471
person
Provider Business Mailing Address Details
Address
740 Mckinley Ave
City
State
Zip
83837-2693
Phone Number
208-783-1267
Fax Number
208-786-4471
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
PA28 (Idaho)
Definition
Definition to come...
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