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1740 E 17th St Idaho Falls ID 83404-6365 | |
| (208) 535-3615 | |
| (208) 523-5343 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1740 E 17th St, Idaho Falls, Idaho |
| Authorized Official Name and Position | Jacob Erickson (CEO) |
| Authorized Official Contact | 2087853801 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
98 Poplar St Blackfoot ID 83221-1758 Ph: (208) 782-3969 | 1740 E 17th St Idaho Falls ID 83404-6365 Ph: (208) 535-3615 |
| NPI Number | 1215398672 |
|---|---|
| Provider Enumeration Date | 03/14/2016 |
| Last Update Date | 12/17/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215398672 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Idaho) | Primary |
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