| Mangum Primary Care Llc | |
|
3046 S Bown Way Boise ID 83706-5499 | |
| (801) 793-8124 | |
| Not Available |
| Full Name | Mangum Primary Care Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 3046 S Bown Way, Boise, Idaho |
| Authorized Official Name and Position | Meredith Kaye Mangum (OWNER) |
| Authorized Official Contact | 8017938124 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mangum Primary Care Llc 608 S Phillippi St Boise ID 83705-1160 Ph: (801) 793-8124 | Mangum Primary Care Llc 3046 S Bown Way Boise ID 83706-5499 Ph: (801) 793-8124 |
| NPI Number | 1194494229 |
|---|---|
| Provider Enumeration Date | 09/11/2021 |
| Last Update Date | 09/11/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194494229 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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