| Physicians & Surgeons Clinic Of Pocatello | |
|
1151 Hospital Way # D-100 Pocatello ID 83201-5091 | |
| (208) 239-8010 | |
| (208) 782-2974 |
| Full Name | Physicians & Surgeons Clinic Of Pocatello |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1151 Hospital Way # D-100, Pocatello, Idaho |
| Authorized Official Name and Position | Jacob Erickson (CEO) |
| Authorized Official Contact | 2087853801 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Physicians & Surgeons Clinic Of Pocatello 98 Poplar St Blackfoot ID 83221-1758 Ph: (208) 785-4100 | Physicians & Surgeons Clinic Of Pocatello 1151 Hospital Way # D-100 Pocatello ID 83201-5091 Ph: (208) 239-8010 |
| NPI Number | 1114192986 |
|---|---|
| Provider Enumeration Date | 04/23/2008 |
| Last Update Date | 12/17/2019 |
| Certification Date | 12/17/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114192986 | NPI | - | NPPES |
| 002854200 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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