| Family Practice Medical | |
|
777 N Raymond St Boise ID 83704-9251 | |
| (208) 367-6030 | |
| Not Available |
| Full Name | Family Practice Medical |
|---|---|
| Speciality | Social Worker |
| Location | 777 N Raymond St, Boise, Idaho |
| Authorized Official Name and Position | Tom C Ahlrichs (SOCIAL WORKER) |
| Authorized Official Contact | 2083676030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Practice Medical 6318 Bermuda Dr Boise ID 83709-1009 Ph: (208) 378-0070 | Family Practice Medical 777 N Raymond St Boise ID 83704-9251 Ph: (208) 367-6030 |
| NPI Number | 1649392200 |
|---|---|
| Provider Enumeration Date | 04/04/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649392200 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | LCSW-24633 (Idaho) | Primary |
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