| Not Tsoo Gah Nee | |
|
717 Mission Rd Ft Hall ID 83203 | |
| (208) 238-5427 | |
| Not Available |
| Full Name | Not Tsoo Gah Nee |
|---|---|
| Speciality | Clinic/center - Public Health, Federal |
| Location | 717 Mission Rd, Ft Hall, Idaho |
| Authorized Official Name and Position | Kellie Ann Alcorn (LPN) |
| Authorized Official Contact | 2082385427 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Not Tsoo Gah Nee Po Box 717 Mission Rd Ft Hall ID 83203 Ph: (208) 238-5427 | Not Tsoo Gah Nee 717 Mission Rd Ft Hall ID 83203 Ph: (208) 238-5427 |
| NPI Number | 1366801458 |
|---|---|
| Provider Enumeration Date | 02/17/2016 |
| Last Update Date | 02/17/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366801458 | NPI | - | NPPES |
| 003398900 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0904X | Clinic/center - Public Health, Federal | PN-15140 (Idaho) | Primary |