Family & Functional Medicine Of Idaho Pllc | |
450 W State St Suite 250 Eagle ID 83616-7057 | |
(208) 947-0925 | |
(208) 947-0926 |
Full Name | Family & Functional Medicine Of Idaho Pllc |
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Speciality | Family Medicine |
Location | 450 W State St, Eagle, Idaho |
Authorized Official Name and Position | Angela L House (PHYSICIAN / OWNER) |
Authorized Official Contact | 2089470925 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Family & Functional Medicine Of Idaho Pllc 450 W State St Suite 250 Eagle ID 83616-7057 Ph: (208) 947-0925 | Family & Functional Medicine Of Idaho Pllc 450 W State St Suite 250 Eagle ID 83616-7057 Ph: (208) 947-0925 |
NPI Number | 1114352242 |
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Provider Enumeration Date | 09/09/2013 |
Last Update Date | 09/09/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114352242 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 0-O370 (Idaho) | Primary |
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