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1545 E Iron Eagle Dr Ste 101 Eagle ID 83616-7079 | |
| (208) 906-9128 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1545 E Iron Eagle Dr Ste 101, Eagle, Idaho |
| Authorized Official Name and Position | Amanda Wilkinson (BUSINESS OPERATIONS DIRECTOR) |
| Authorized Official Contact | 7028180446 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1545 E Iron Eagle Dr Ste 101 Eagle ID 83616-7079 Ph: () - | 1545 E Iron Eagle Dr Ste 101 Eagle ID 83616-7079 Ph: (208) 906-9128 |
| NPI Number | 1649925389 |
|---|---|
| Provider Enumeration Date | 02/21/2022 |
| Last Update Date | 11/11/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649925389 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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