Healthcare Provider Details

I. General information

NPI: 1831029743
Provider Name (Legal Business Name): FIRST CARE MEDICAL OF IDAHO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S WOODRUFF AVE STE 7
IDAHO FALLS ID
83404-6371
US

IV. Provider business mailing address

2168 W GROVE PKWY STE 200
PLEASANT GROVE UT
84062-6748
US

V. Phone/Fax

Practice location:
  • Phone: 208-534-6900
  • Fax: 208-534-6903
Mailing address:
  • Phone: 801-899-2053
  • Fax: 801-899-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATE D MILLER
Title or Position: PRESIDENT
Credential: DC
Phone: 801-899-2053