Healthcare Provider Details

I. General information

NPI: 1598935652
Provider Name (Legal Business Name): FREMONT MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 S 8TH ST
ASHTON ID
83420
US

IV. Provider business mailing address

PO BOX 826
ASHTON ID
83420-0826
US

V. Phone/Fax

Practice location:
  • Phone: 208-652-3396
  • Fax:
Mailing address:
  • Phone: 208-652-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberM4566
License Number StateID

VIII. Authorized Official

Name: DR. STEPHEN CHEYNE
Title or Position: PRESIDENT
Credential: MD
Phone: 208-624-4402