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252 South Main Street Victor ID 83455 | |
(208) 354-6307 | |
(208) 787-7456 |
Full Name | |
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Speciality | Family Medicine |
Location | 252 South Main Street, Victor, Idaho |
Authorized Official Name and Position | Laura C Piquet (OPERATIONS MANAGER) |
Authorized Official Contact | 2083546302 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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120 East Howard Avenue Driggs ID 83422-5112 Ph: (208) 354-6307 | 252 South Main Street Victor ID 83455 Ph: (208) 354-6307 |
NPI Number | 1881734135 |
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Provider Enumeration Date | 02/07/2007 |
Last Update Date | 11/18/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881734135 | NPI | - | NPPES |
000010031568 | Other | ID | REGENCE BLUE SHIELD |
807736300 | Medicaid | ID | |
8M954 | Other | ID | BLUE CROSS |