Provider Demographics
NPI:1194802108
Name:KAREN E FISHER ENT
Entity type:Organization
Organization Name:KAREN E FISHER ENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:208-788-4970
Mailing Address - Street 1:21 E MAPLE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8401
Mailing Address - Country:US
Mailing Address - Phone:208-788-4970
Mailing Address - Fax:208-788-1099
Practice Address - Street 1:21 E MAPLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8401
Practice Address - Country:US
Practice Address - Phone:208-788-4970
Practice Address - Fax:208-788-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002621300Medicaid
ID002621300Medicaid