| Colleen Shackelford, Llc | |
|
300 E Bannock St Boise ID 83712 | |
| (208) 342-7400 | |
| (208) 342-1879 |
| Full Name | Colleen Shackelford, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 300 E Bannock St, Boise, Idaho |
| Authorized Official Name and Position | Colleen Shackelford (OWNER) |
| Authorized Official Contact | 2083427400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Colleen Shackelford, Llc 300 E Bannock St Boise ID 83712 Ph: (208) 342-7400 | Colleen Shackelford, Llc 300 E Bannock St Boise ID 83712 Ph: (208) 342-7400 |
| NPI Number | 1689744963 |
|---|---|
| Provider Enumeration Date | 11/08/2006 |
| Last Update Date | 07/25/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689744963 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M5741 (Idaho) | Primary |
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