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203 N A St Grangeville ID 83530-1201 | |
| (208) 983-3000 | |
| (208) 983-9276 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 203 N A St, Grangeville, Idaho |
| Authorized Official Name and Position | Jim Gardner (PRESIDENT) |
| Authorized Official Contact | 2089833000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
203 N A St Grangeville ID 83530-1201 Ph: (208) 983-3000 | 203 N A St Grangeville ID 83530-1201 Ph: (208) 983-3000 |
| NPI Number | 1477551794 |
|---|---|
| Provider Enumeration Date | 07/11/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477551794 | NPI | - | NPPES |
| G02767400 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M6671 (Idaho) | Secondary |
| 207Q00000X | Family Medicine | M6670 (Idaho) | Primary |
| 207Q00000X | Family Medicine | NP416A (Idaho) | Secondary |
Mountain State Family Medicine, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 610 Nw 2nd St, Grangeville, ID 83530 Phone: 208-983-5120 Fax: 208-983-5404 | |
Haug Chiropractic Clinic, P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 113 S A St, Grangeville, ID 83530 Phone: 208-983-2458 Fax: 208-983-1554 |