| Idaho State University Department Of Family Medicine | |
|
465 Memorial Dr Pocatello ID 83201-4008 | |
| (208) 282-4141 | |
| Not Available |
| Full Name | Idaho State University Department Of Family Medicine |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 465 Memorial Dr, Pocatello, Idaho |
| Authorized Official Name and Position | Laurie Powell (AUTHORIZATION SPECIALIST) |
| Authorized Official Contact | 2082326260 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho State University Department Of Family Medicine 1000 N 8th Ave Pocatello ID 83201-5757 Ph: (208) 232-6260 | Idaho State University Department Of Family Medicine 465 Memorial Dr Pocatello ID 83201-4008 Ph: (208) 282-4141 |
| NPI Number | 1780032326 |
|---|---|
| Provider Enumeration Date | 05/24/2016 |
| Last Update Date | 05/24/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780032326 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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