Healthcare Provider Details

I. General information

NPI: 1346441912
Provider Name (Legal Business Name): WOOD RIVER FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 S MAIN ST
HAILEY ID
83333-8400
US

IV. Provider business mailing address

706 S MAIN ST
HAILEY ID
83333-8400
US

V. Phone/Fax

Practice location:
  • Phone: 208-788-3434
  • Fax: 208-788-2025
Mailing address:
  • Phone: 208-788-3434
  • Fax: 208-788-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: CARL A BARBEE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 208-788-3434