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1281 E. Iron Eagle Dr Eagle ID 83616-9117 | |
| (208) 939-5535 | |
| (208) 939-5536 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1281 E. Iron Eagle Dr, Eagle, Idaho |
| Authorized Official Name and Position | Vicki L Wooll (OWNER) |
| Authorized Official Contact | 2089395535 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1281 E. Iron Eagle Dr Eagle ID 83616-9117 Ph: (208) 939-5535 | 1281 E. Iron Eagle Dr Eagle ID 83616-9117 Ph: (208) 939-5535 |
| NPI Number | 1053494146 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 02/10/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053494146 | NPI | - | NPPES |
| 805943000 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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