Healthcare Provider Details

I. General information

NPI: 1538578687
Provider Name (Legal Business Name): URGENT CARE OF IDAHO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2014
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W AVENUE A SUITE B
JEROME ID
83338-2630
US

IV. Provider business mailing address

PO BOX 773
JEROME ID
83338-5483
US

V. Phone/Fax

Practice location:
  • Phone: 208-324-2004
  • Fax: 208-324-1154
Mailing address:
  • Phone: 208-324-2004
  • Fax: 208-324-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-154
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-9766
License Number StateID

VIII. Authorized Official

Name: KYLE JAMES
Title or Position: CO-OWNER
Credential:
Phone: 208-678-6996