Id Dept of Health & Welfare CSHP (HD1)
Organization Active NPI Pediatrics Physician · Hayden, ID
NPI 1962625764 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1962625764
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- ID DEPT OF HEALTH & WELFARE CSHP (HD1)
- Practice address
- 8500 N Atlas Rd
Hayden, ID 83835-8332 - Phone
- (208) 415-5136
- Fax
- (208) 415-5131
- NPI assigned
- Apr 10, 2007
- Organization subpart
- No
Authorized official
- Name
- Paige Fincher, BSW
- Title
- Acting Program Manager
- Phone
- (208) 334-4935
Corporate family (same tax ID) 15
National Provider Directory
- Tax ID family
- Reg VI Mental Health Ctr
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
8500 N Atlas Rd
Hayden, ID 83835-8332
Mailing address
PO Box 83720
4TH Floor
Boise, ID 83720-0036
Phone (208) 334-4935
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0024706 | Medicaid | ID | |
| 000010022948 | Other | ID | BLUE SHIELD |
| HW207 | Other | ID | BLUE CROSS OF ID |
Other providers in Hayden, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.