| Idaho Dept Of Health & Welfare Amhcalpgreg3 | |
|
3402 Franklin Rd Caldwell ID 83605-6932 | |
| (208) 459-0092 | |
| (208) 454-7714 |
| Full Name | Idaho Dept Of Health & Welfare Amhcalpgreg3 |
|---|---|
| Speciality | Psychologist - Prescribing (medical) |
| Location | 3402 Franklin Rd, Caldwell, Idaho |
| Authorized Official Name and Position | Todd L Hurt (FIELD OPERATIONS MANAGER) |
| Authorized Official Contact | 2084557057 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Dept Of Health & Welfare Amhcalpgreg3 3402 Franklin Rd Caldwell ID 83605-6932 Ph: (208) 459-0092 | Idaho Dept Of Health & Welfare Amhcalpgreg3 3402 Franklin Rd Caldwell ID 83605-6932 Ph: (208) 459-0092 |
| NPI Number | 1104004928 |
|---|---|
| Provider Enumeration Date | 02/04/2008 |
| Last Update Date | 01/28/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104004928 | NPI | - | NPPES |
| HW298 | Other | BLUE CROSS OF IDAHO | |
| 8076191 | Medicaid | ID | |
| 000010027633 | Other | ID | BLUESHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | (* (Not Available)) | Primary |
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