Healthcare Provider Details

I. General information

NPI: 1124015342
Provider Name (Legal Business Name): FAMILY CARE PHYSICIANS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 5TH AVE W
JEROME ID
83338-1825
US

IV. Provider business mailing address

112 5TH AVE W
JEROME ID
83338-1825
US

V. Phone/Fax

Practice location:
  • Phone: 208-324-1157
  • Fax: 208-324-3604
Mailing address:
  • Phone: 208-324-1157
  • Fax: 208-324-3604

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: DR. JAMES S IRWIN
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 208-324-1157