Healthcare Provider Details

I. General information

NPI: 1093513731
Provider Name (Legal Business Name): WENDELL FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N IDAHO ST
WENDELL ID
83355-5038
US

IV. Provider business mailing address

PO BOX 505
WENDELL ID
83355-0505
US

V. Phone/Fax

Practice location:
  • Phone: 208-990-3226
  • Fax: 888-440-7959
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRITTNI MCLAM
Title or Position: PHYSICIAN OWNER
Credential: DO
Phone: 208-990-3241