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General NPI Number Information
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NPI Number | 1336526771
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Entity Type | Organization
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Legal Business Name | QUIK-MED HEALTH CLINIC PLLC
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 104 E 4TH AVE
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City | CLARK FORK
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State | ID
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Zip | 83811
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Country | US
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Telephone | 208-946-5100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 567
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City | CLARK FORK
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State | ID
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Zip | 83811-0567
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Country | US
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Telephone | 208-946-5100
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Fax |
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Authorized Official
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Title or Position | RN
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Name | BETTY ANNE GILLEY
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Credential | RN,MSM,FNP-C
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Telephone | 208-946-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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