Provider Demographics
NPI:1194147850
Name:PACKHAM INSURANCE AGENCY
Entity type:Organization
Organization Name:PACKHAM INSURANCE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:O
Authorized Official - Last Name:PACKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-785-2525
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-0039
Mailing Address - Country:US
Mailing Address - Phone:208-787-5252
Mailing Address - Fax:208-785-2526
Practice Address - Street 1:17 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2710
Practice Address - Country:US
Practice Address - Phone:208-785-2525
Practice Address - Fax:208-785-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID13001251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage