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General NPI Number Information
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NPI Number | 1528251519
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Entity Type | Organization
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Legal Business Name | MAGIC VALLEY FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 1182 EASTLAND DR N SUITE B
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City | TWIN FALLS
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State | ID
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Zip | 83301-8972
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Country | US
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Telephone | 208-733-5117
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Fax | 208-733-5143
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Provider Business Mailing Address
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Address Line | 1182 EASTLAND DR N SUITE B
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City | TWIN FALLS
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State | ID
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Zip | 83301-8972
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Country | US
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Telephone | 208-733-5117
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Fax | 208-733-5143
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MR. DREW B SIMMONS
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Credential | FNP-C
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Telephone | 208-733-5117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | NP444A
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License Number State | ID
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