Healthcare Provider Details

I. General information

NPI: 1326002650
Provider Name (Legal Business Name): ASSOCIATES IN FAMILY PRACTICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 IDAHO ST
GOODING ID
83330
US

IV. Provider business mailing address

PO BOX 447
GOODING ID
83330
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-5900
  • Fax: 208-934-5719
Mailing address:
  • Phone: 208-934-5900
  • Fax: 208-934-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSIE THOMPSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 208-934-5900