NPI 1033554845

Michael A. Bloom D.M.D. PLLC

Organisation Health Maintenance Organization Hayden Lake, ID

Practice location

Address: 9928 N Government Way, Hayden Lake, ID 83835-9604
Phone: (208) 772-3583
Fax: (208) 772-3224
Mailing address: PO Box 425, Hayden Lake, ID 83835-0425

Authorised official

Name: Kathy L. Marks
Title: Office Manager
Phone: (208) 772-3583

Registered specialties (2)

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X Licence D3394 (ID)

Other Health Maintenance Organization providers in Idaho →

Health Maintenance Organization

Managed Care Organizations Taxonomy 302R00000X Licence D3555 (ID)

Registry record

NPI: 1033554845
Entity type: Organization
NPI issued: 7 May 2013
Record last updated: 7 May 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.