Provider Demographics
NPI:1730471210
Name:IDAHO HEALTH SCREENINGS & VACCINATIONS
Entity Type:Organization
Organization Name:IDAHO HEALTH SCREENINGS & VACCINATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-378-4584
Mailing Address - Street 1:9238 W BEACHSIDE LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-6712
Mailing Address - Country:US
Mailing Address - Phone:208-378-4584
Mailing Address - Fax:208-376-3831
Practice Address - Street 1:9238 W BEACHSIDE LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6712
Practice Address - Country:US
Practice Address - Phone:208-378-4584
Practice Address - Fax:208-376-3831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory