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General NPI Number Information
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NPI Number | 1194533992
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Entity Type | Organization
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Legal Business Name | PERPETUAL FAMILY MEDICINE
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Dates
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Enumeration Date | 12/26/2024
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 1717 LINCOLN WAY STE 108
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2556
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Country | US
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Telephone | 208-480-6174
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Fax | 208-601-6174
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Provider Business Mailing Address
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Address Line | 1717 LINCOLN WAY STE 108
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2556
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Country | US
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Telephone | 208-480-6174
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Fax | 208-601-6174
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MARK CHRISTOPHER MARTINDALE
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Credential | PA-C
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Telephone | 208-480-6174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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