| Idalis Inc | |
|
3663 College St Se Ste A Lacey WA 98503-3529 | |
| (360) 413-1728 | |
| (360) 413-1669 |
| Full Name | Idalis Inc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 3663 College St Se Ste A, Lacey, Washington |
| Authorized Official Name and Position | Samuel E Coor (OWNER) |
| Authorized Official Contact | 3604131728 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idalis Inc 3663 College St Se Ste A Lacey WA 98503-3529 Ph: (360) 413-1728 | Idalis Inc 3663 College St Se Ste A Lacey WA 98503-3529 Ph: (360) 413-1728 |
| NPI Number | 1184640591 |
|---|---|
| Provider Enumeration Date | 07/15/2006 |
| Last Update Date | 12/10/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184640591 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 06-00027820 (Washington) | Primary |
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