National Provider Identifier Database

BLUE LAKES MEDICINE PA
Family


Contact Information

BLUE LAKES MEDICINE PA
1122 EASTLAND DR N
STE 2
TWIN FALLS, ID83301-8444
Phone: 208-734-9531
Fax: 208-733-6969
Website:
Specialty Taxonomy Code
* Family 363LF0000X

* Indicates primary specialty

NPI Profile & details for BLUE LAKES MEDICINE PA

NPI Number 1063872489
Legal business name
LBN
BLUE LAKES MEDICINE PA
Authorized official HOWARD ARRINGTON - (PROVIDER / OWNER)
Entity Organization
Organization subpart No
Enumeration date 02/26/2016
Last updated 02/26/2016 - About 10 years ago
Sole proprietor1 Not specified
Identifiers
  • ID License #: NP-1688A
  • ID Other: 1374328 MEDICARE PTAN

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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