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General NPI Number Information
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NPI Number | 1912481292
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Entity Type | Organization
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Legal Business Name | FALLS AVENUE IMMEDIATE CARE PA
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 260 FALLS AVE STE D
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City | TWIN FALLS
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State | ID
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Zip | 83301-3370
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Country | US
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Telephone | 208-733-6700
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Fax | 208-733-0803
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Provider Business Mailing Address
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Address Line | 260 FALLS AVE STE D
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City | TWIN FALLS
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State | ID
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Zip | 83301-3370
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Country | US
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Telephone | 208-733-6700
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Fax | 208-733-0803
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Authorized Official
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Title or Position | OWNER
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Name | W SCOTT RUDEEN
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Credential | MD
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Telephone | 208-733-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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