Provider Demographics
NPI:1588991566
Name:ASHTON MEMORIAL, INC.
Entity type:Organization
Organization Name:ASHTON MEMORIAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHULDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-652-7461
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:ID
Mailing Address - Zip Code:83420-0838
Mailing Address - Country:US
Mailing Address - Phone:208-652-7461
Mailing Address - Fax:208-652-7595
Practice Address - Street 1:23 S. 8TH
Practice Address - Street 2:
Practice Address - City:ASHTON
Practice Address - State:ID
Practice Address - Zip Code:83420
Practice Address - Country:US
Practice Address - Phone:208-652-3396
Practice Address - Fax:208-652-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service