Provider Demographics
NPI:1821205188
Name:EASTERN IDAHO PUBLIC HEALTH DISTRICT
Entity Type:Organization
Organization Name:EASTERN IDAHO PUBLIC HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-522-0310
Mailing Address - Street 1:1250 HOLLIPARK DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-6217
Mailing Address - Country:US
Mailing Address - Phone:208-522-0310
Mailing Address - Fax:208-525-7063
Practice Address - Street 1:1250 HOLLIPARK DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-6217
Practice Address - Country:US
Practice Address - Phone:208-522-0310
Practice Address - Fax:208-525-7063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002471500Medicaid