Provider Demographics
NPI:1780398586
Name:SIPI CLINIC LLC
Entity type:Organization
Organization Name:SIPI CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-733-3181
Mailing Address - Street 1:176 FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-2306
Mailing Address - Country:US
Mailing Address - Phone:208-733-3181
Mailing Address - Fax:208-733-3168
Practice Address - Street 1:176 FALLS AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-2306
Practice Address - Country:US
Practice Address - Phone:208-733-3181
Practice Address - Fax:208-733-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty