| Fremont Family Medicine Pc | |
|
30 W Main St Saint Anthony ID 83445-2113 | |
| (208) 680-2716 | |
| Not Available |
| Full Name | Fremont Family Medicine Pc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 30 W Main St, Saint Anthony, Idaho |
| Authorized Official Name and Position | Ronald K Ellsworth (DOCTOR/OWNER) |
| Authorized Official Contact | 2086802716 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fremont Family Medicine Pc 30 W Main St Saint Anthony ID 83445-2113 Ph: (208) 680-2716 | Fremont Family Medicine Pc 30 W Main St Saint Anthony ID 83445-2113 Ph: (208) 680-2716 |
| NPI Number | 1255704177 |
|---|---|
| Provider Enumeration Date | 11/02/2015 |
| Last Update Date | 11/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255704177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | M-11978 (Idaho) | Primary |
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