1144519463 NPI number — ENHANCE DME LLC

Table of content: JAMES PATRICK WATT M.D. (NPI 1457567489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144519463 NPI number — ENHANCE DME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENHANCE DME LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144519463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1033 W QUINN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83202-2425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-233-4800
Provider Business Mailing Address Fax Number:
208-233-4887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1033 W QUINN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83202-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-233-4800
Provider Business Practice Location Address Fax Number:
208-233-4887
Provider Enumeration Date:
04/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LEMON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
208-233-4800

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DME16016 . This is a "STATE OF IDAHO BOARD OF PHARMACY DME" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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