Provider Demographics
NPI:1528226982
Name:EASTERN IDAHO MEDICAL SUPPLY COMPANY
Entity Type:Organization
Organization Name:EASTERN IDAHO MEDICAL SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-589-2897
Mailing Address - Street 1:3800 TAYLORVIEW LN
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-8145
Mailing Address - Country:US
Mailing Address - Phone:208-589-2897
Mailing Address - Fax:
Practice Address - Street 1:3800 TAYLORVIEW LN
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-8145
Practice Address - Country:US
Practice Address - Phone:208-589-2897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-01
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies