Healthcare Provider Details

I. General information

NPI: 1114141090
Provider Name (Legal Business Name): PHYSICIANS IMMEDIATE CARE OF TWIN FALLS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CHENEY DR W STE 200
TWIN FALLS ID
83301-3721
US

IV. Provider business mailing address

243 CHENEY DR W STE 200
TWIN FALLS ID
83301-3721
US

V. Phone/Fax

Practice location:
  • Phone: 208-736-7422
  • Fax: 208-736-8905
Mailing address:
  • Phone: 208-736-7422
  • Fax: 208-736-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEREMY WILLES
Title or Position: VICE PRESIDENT
Credential: PA-C
Phone: 208-736-7422