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General NPI Number Information
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NPI Number | 1477689198
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Entity Type | Organization
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Legal Business Name | NORTH IDAHO FAMILY CARE
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 925 E POLSTON AVE
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City | POST FALLS
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State | ID
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Zip | 83854-9049
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Country | US
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Telephone | 208-773-9113
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Fax | 208-773-4911
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Provider Business Mailing Address
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Address Line | 927 E POLSTON AVE SUITE 303
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City | POST FALLS
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State | ID
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Zip | 83854-9811
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Country | US
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Telephone | 208-664-3313
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Fax | 208-664-2793
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | MS. SHANNON K HARRIS
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Credential |
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Telephone | 208-664-3313
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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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