| Idaho Physicians Clinic | |
|
98 Poplar St Blackfoot ID 83221-1758 | |
| (208) 785-3800 | |
| Not Available |
| Full Name | Idaho Physicians Clinic |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 98 Poplar St, Blackfoot, Idaho |
| Authorized Official Name and Position | Louis Kraml (CEO) |
| Authorized Official Contact | 2087853804 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Physicians Clinic 98 Poplar St Blackfoot ID 83221-1758 Ph: (208) 785-3800 | Idaho Physicians Clinic 98 Poplar St Blackfoot ID 83221-1758 Ph: (208) 785-3800 |
| NPI Number | 1114907532 |
|---|---|
| Provider Enumeration Date | 01/20/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114907532 | NPI | - | NPPES |
| 8F496 | Other | ID | BLUE CROSS PROVIDER # |
| 000010137702 | Other | ID | BLUE SHIELD PROVIDER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 36 (Idaho) | Primary |
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