MEDICARE: MUELLER CARE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1336305739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUELLER CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	2860 CHANNING WAY STE 211
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7541
Country	:	US
Telephone Number	:	208-522-2273
Fax Number	:	208-522-4941

Provider Business Practice Location Address
First Line	:	2860 CHANNING WAY STE 211
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7541
Country	:	US
Telephone Number	:	208-522-2273
Fax Number	:	208-522-4941

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SAMANTHA SMITH
Credential	:
Telephone Number	:	208-522-2273

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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