Provider Demographics
NPI:1841212933
Name:PUBLIC HEALTH DISTRICT 1
Entity Type:Organization
Organization Name:PUBLIC HEALTH DISTRICT 1
Other - Org Name:PANHANDLE HEALTH DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-415-5163
Mailing Address - Street 1:8500 N ATLAS ROAD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-7677
Mailing Address - Country:US
Mailing Address - Phone:208-786-7474
Mailing Address - Fax:208-786-7109
Practice Address - Street 1:8500 N ATLAS RD
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8332
Practice Address - Country:US
Practice Address - Phone:208-415-5100
Practice Address - Fax:208-415-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000270500Medicaid
IDDH124OtherBLUE CROSS OF IDAHO
IDDH132OtherBLUE CROSS OF IDAHO
DE000010023565OtherREGENCE BLUE SHIELD OF ID
DE000010024099OtherREGENCE BLUE SHIELD OF ID
ID000010008200OtherREGENCE BLUE SHIELD OF ID
ID002843400Medicaid
IDDH0017OtherBLUE CROSS OF IDAHO
IDDJ780OtherBLUE CROSS OF IDAHO
ID002470500Medicaid
ID000010018276OtherREGENCE BLUE SHIELD OF ID
IDDH116OtherBLUE CROSS OF IDAHO
ID000010021347OtherREGENCE BLUE SHIELD OF ID
ID002834500Medicaid