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General NPI Number Information
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NPI Number | 1114907532
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Entity Type | Organization
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Legal Business Name | IDAHO PHYSICIANS CLINIC
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 98 POPLAR ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1758
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Country | US
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Telephone | 208-785-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 98 POPLAR ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1758
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Country | US
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Telephone | 208-785-3800
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LOUIS KRAML
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Credential |
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Telephone | 208-785-3804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 36
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License Number State | ID
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