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General NPI Number Information
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NPI Number | 1619038346
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Entity Type | Organization
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Legal Business Name | ADULT AND GERIATRIC MEDICAL CARE, P.C.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2003 LINCOLN WAY KMC MED STAFF OFFICE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2611
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Country | US
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Telephone | 208-651-1092
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Fax | 877-234-0633
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Provider Business Mailing Address
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Address Line | PO BOX 238
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City | HAYDEN
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State | ID
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Zip | 83835-0238
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Country | US
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Telephone | 208-651-1092
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Fax | 877-234-0633
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. SUSAN MELCHIORE
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Credential | M.D.
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Telephone | 208-651-1092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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