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General NPI Number Information
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NPI Number | 1407994528
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Entity Type | Organization
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Legal Business Name | FOUR PEAKS CLINIC URGENT CARE, INC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 141 VALLEY CENTER DR
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City | DRIGGS
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State | ID
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Zip | 83422-5113
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Country | US
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Telephone | 208-354-4757
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Fax | 208-354-4758
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Provider Business Mailing Address
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Address Line | 141 VALLEY CENTER DR
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City | DRIGGS
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State | ID
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Zip | 83422-5113
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Country | US
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Telephone | 208-354-4757
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Fax | 208-354-4758
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT D THOMAS
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Credential | MD
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Telephone | 208-354-4757
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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 | M7462
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License Number State | ID
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