Provider Demographics
NPI:1538251996
Name:CHALLIS AREA HEALTH CENTER
Entity type:Organization
Organization Name:CHALLIS AREA HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-879-4351
Mailing Address - Street 1:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:CHALLIS
Mailing Address - State:ID
Mailing Address - Zip Code:83226-0980
Mailing Address - Country:US
Mailing Address - Phone:208-879-4351
Mailing Address - Fax:208-879-5216
Practice Address - Street 1:1 CLINIC ROAD
Practice Address - Street 2:
Practice Address - City:CHALLIS
Practice Address - State:ID
Practice Address - Zip Code:83226-0980
Practice Address - Country:US
Practice Address - Phone:208-879-4351
Practice Address - Fax:208-879-5216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805056300Medicaid
ID805056300Medicaid