Provider Demographics
NPI: | 1457067381 |
---|---|
Name: | HEALTH WEST, INC. |
Entity Type: | Organization |
Organization Name: | HEALTH WEST, INC. |
Other - Org Name: | HEALTH WEST NORTH LOGAN |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MEDICAL STAFF COORDINATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | AMELIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MURPHY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 208-232-7862 |
Mailing Address - Street 1: | 500 S 11TH AVE STE 400 |
Mailing Address - Street 2: | |
Mailing Address - City: | POCATELLO |
Mailing Address - State: | ID |
Mailing Address - Zip Code: | 83201-4880 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 208-232-7862 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1515 N 400 E STE 104 |
Practice Address - Street 2: | |
Practice Address - City: | NORTH LOGAN |
Practice Address - State: | UT |
Practice Address - Zip Code: | 84341-7595 |
Practice Address - Country: | US |
Practice Address - Phone: | 435-755-6061 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | HEALTH WEST, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-01-24 |
Last Update Date: | 2024-01-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |