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2410 E 25th St Idaho Falls ID 83404 | |
| (208) 557-0200 | |
| (208) 542-5080 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 2410 E 25th St, Idaho Falls, Idaho |
| Authorized Official Name and Position | Laramie L. Wheeler (OWNER) |
| Authorized Official Contact | 2085570200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2410 E 25th St Idaho Falls ID 83404-7549 Ph: (208) 557-0200 | 2410 E 25th St Idaho Falls ID 83404 Ph: (208) 557-0200 |
| NPI Number | 1275963589 |
|---|---|
| Provider Enumeration Date | 11/22/2013 |
| Last Update Date | 08/22/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275963589 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | O-0426 (Idaho) | Primary |
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