Healthcare Provider Details

I. General information

NPI: 1386985851
Provider Name (Legal Business Name): JFK CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N CAPITOL BLVD
BOISE ID
83702-5920
US

IV. Provider business mailing address

300 2ND AVE NE STE 113
JAMESTOWN ND
58401-3373
US

V. Phone/Fax

Practice location:
  • Phone: 701-251-3085
  • Fax:
Mailing address:
  • Phone: 701-251-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANGIE HOFFMANN
Title or Position: DIRECTOR
Credential:
Phone: 701-251-3085