Provider Demographics
NPI:1699942383
Name:PATIENTS FIRST NEUROLOGY LLC
Entity type:Organization
Organization Name:PATIENTS FIRST NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-568-5999
Mailing Address - Street 1:2860 CHANNING WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7531
Mailing Address - Country:US
Mailing Address - Phone:208-535-4585
Mailing Address - Fax:208-535-4569
Practice Address - Street 1:2860 CHANNING WAY
Practice Address - Street 2:STE 100
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7531
Practice Address - Country:US
Practice Address - Phone:208-535-4585
Practice Address - Fax:208-535-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1699942383Medicaid
WY1699942383Medicaid
ID8N521OtherBLUE CROSS OF ID
ID8N521OtherBLUE CROSS OF ID
MT1699942383Medicaid