Provider Demographics
NPI:1104419423
Name:A2C CORPORATION
Entity type:Organization
Organization Name:A2C CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHERYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-252-5621
Mailing Address - Street 1:333 W CEDAR ST STE 3
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5045
Mailing Address - Country:US
Mailing Address - Phone:208-252-5621
Mailing Address - Fax:208-648-4167
Practice Address - Street 1:333 W CEDAR ST STE 3
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5045
Practice Address - Country:US
Practice Address - Phone:208-252-5621
Practice Address - Fax:208-648-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty