Provider Demographics
NPI:1851511224
Name:PANHANDLE HEALTH DISTRICT
Entity Type:Organization
Organization Name:PANHANDLE HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BOCK
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANNIE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:208-415-5100
Mailing Address - Street 1:8500 N ATLAS RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835
Mailing Address - Country:US
Mailing Address - Phone:208-415-5100
Mailing Address - Fax:208-415-5101
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
Practice Address - Country:US
Practice Address - Phone:208-415-5100
Practice Address - Fax:208-415-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDID NP 99251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare