Provider Demographics
NPI:1326009648
Name:PUBLIC HEALTH DISTRICT IV
Entity Type:Organization
Organization Name:PUBLIC HEALTH DISTRICT IV
Other - Org Name:CENTRAL DISTRICT HEALTH DEPT.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMURTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-327-7400
Mailing Address - Street 1:707 N ARMSTRONG PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-0825
Mailing Address - Country:US
Mailing Address - Phone:208-375-5211
Mailing Address - Fax:208-327-8500
Practice Address - Street 1:707 N ARMSTRONG PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-0825
Practice Address - Country:US
Practice Address - Phone:208-375-5211
Practice Address - Fax:208-327-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 207Q00000X
N/A PUBLIC HEALTH AG251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805808800Medicaid
ID002469400Medicaid
ID002831400Medicaid
ID806152200Medicaid
IDDH041OtherBLUE CROSS OF IDAHO
ID000010007076OtherREGENCE BLUE SHIELD OF ID
ID002469200Medicaid
ID002469700Medicaid
ID806919800Medicaid
ID002469200Medicaid