Provider Demographics
NPI:1417026626
Name:BERTHA WHITNEY
Entity type:Organization
Organization Name:BERTHA WHITNEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:ELDER
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING CONSULTANT
Authorized Official - Phone:208-746-8547
Mailing Address - Street 1:9751 N GOVT WAY STE 6
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9645
Mailing Address - Country:US
Mailing Address - Phone:208-746-8547
Mailing Address - Fax:208-746-5579
Practice Address - Street 1:1927 IDAHO STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2563
Practice Address - Country:US
Practice Address - Phone:208-746-8547
Practice Address - Fax:208-746-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDH197332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDAU720OtherBLUE CROSS
ID002656800Medicaid
WA123516OtherLABOR INDUSTRIES
WA9040924Medicaid
ID000014644OtherBLUE SHIELD
IDAU738OtherBLUE CROSS