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General NPI Number Information
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NPI Number | 1114141090
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Entity Type | Organization
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Legal Business Name | PHYSICIANS IMMEDIATE CARE OF TWIN FALLS PA
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 243 CHENEY DR W STE 200
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City | TWIN FALLS
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State | ID
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Zip | 83301-3721
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Country | US
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Telephone | 208-736-7422
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Fax | 208-736-8905
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Provider Business Mailing Address
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Address Line | 243 CHENEY DR W STE 200
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City | TWIN FALLS
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State | ID
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Zip | 83301-3721
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Country | US
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Telephone | 208-736-7422
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Fax | 208-736-8905
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JEREMY WILLES
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Credential | PA-C
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Telephone | 208-736-7422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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