Provider Demographics
NPI:1821303504
Name:NATIONWIDE NEURO HEALTH
Entity Type:Organization
Organization Name:NATIONWIDE NEURO HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-454-0567
Mailing Address - Street 1:211 E LOGAN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4882
Mailing Address - Country:US
Mailing Address - Phone:208-454-0567
Mailing Address - Fax:208-454-0965
Practice Address - Street 1:211 E LOGAN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4882
Practice Address - Country:US
Practice Address - Phone:208-454-0567
Practice Address - Fax:208-454-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty