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General NPI Number Information
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NPI Number | 1104351972
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Entity Type | Organization
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Legal Business Name | SALMON RIVER CLINIC
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 403 RIVERFRONT DR
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City | SALMON
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State | ID
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Zip | 83467-5162
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Country | US
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Telephone | 208-742-1110
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Fax | 208-742-1120
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Provider Business Mailing Address
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Address Line | 403 RIVERFRONT DR
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City | SALMON
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State | ID
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Zip | 83467-5162
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Country | US
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Telephone | 208-742-1110
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Fax | 208-742-1120
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DARCI NEYMAN
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Credential |
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Telephone | 208-490-3118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | NP1202A
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License Number State | ID
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