Provider Demographics
NPI:1427616846
Name:PUBLIC HEALTH DISTRICT 1
Entity type:Organization
Organization Name:PUBLIC HEALTH DISTRICT 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-415-5163
Mailing Address - Street 1:8500 NORTH ATLAS ROAD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8332
Mailing Address - Country:US
Mailing Address - Phone:208-415-5100
Mailing Address - Fax:208-415-5101
Practice Address - Street 1:8500 NORTH ATLAS ROAD
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8332
Practice Address - Country:US
Practice Address - Phone:208-415-5100
Practice Address - Fax:208-415-5101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUBLIC HEALTH DISTRICT 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-31
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or LocalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty