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General NPI Number Information
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NPI Number | 1679737217
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Entity Type | Organization
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Legal Business Name | UPPER VALLEY FAMILY MEDICINE PA
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 530 RIGBY LAKE DR
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City | RIGBY
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State | ID
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Zip | 83442-1271
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Country | US
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Telephone | 208-745-5021
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Fax | 208-745-5026
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Provider Business Mailing Address
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Address Line | 530 RIGBY LAKE DR
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City | RIGBY
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State | ID
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Zip | 83442-1271
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Country | US
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Telephone | 208-745-5021
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Fax | 208-745-5026
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CONNIE LYNN SAFARIK
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Credential | CPC
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Telephone | 208-745-6717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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