Provider Demographics
NPI:1366648487
Name:NEUROPATHY CLINIC L.L.C.
Entity Type:Organization
Organization Name:NEUROPATHY CLINIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:208-682-2547
Mailing Address - Street 1:214 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:ID
Mailing Address - Zip Code:83873-2122
Mailing Address - Country:US
Mailing Address - Phone:208-682-2547
Mailing Address - Fax:208-752-1063
Practice Address - Street 1:401 7TH ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:ID
Practice Address - Zip Code:83873-2335
Practice Address - Country:US
Practice Address - Phone:208-752-1019
Practice Address - Fax:208-752-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIN6485171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty