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General NPI Number Information
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NPI Number | 1407026560
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Entity Type | Organization
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Legal Business Name | FREMONT MEDICAL SERVICES PC
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 3765 HIGHWAY 20 S
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City | ISLAND PARK
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State | ID
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Zip | 83429
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Country | US
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Telephone | 208-558-7766
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 826
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City | ASHTON
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State | ID
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Zip | 83420-0826
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN CHEYNE
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Credential | MD
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Telephone | 208-558-7766
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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 | M4566
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License Number State | ID
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