| Mountain States Medical Group Pa | |
|
4809 Fairview Avenue Boise ID 83706-2242 | |
| (208) 378-2840 | |
| (208) 323-9070 |
| Full Name | Mountain States Medical Group Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 4809 Fairview Avenue, Boise, Idaho |
| Authorized Official Name and Position | Richard Mcchrystal (PRESIDENT) |
| Authorized Official Contact | 2083782840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain States Medical Group Pa Po Box 4236 Boise ID 83711-4236 Ph: (208) 378-2840 | Mountain States Medical Group Pa 4809 Fairview Avenue Boise ID 83706-2242 Ph: (208) 378-2840 |
| NPI Number | 1730272006 |
|---|---|
| Provider Enumeration Date | 10/01/2006 |
| Last Update Date | 09/15/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730272006 | NPI | - | NPPES |
| 000010017966 | Other | ID | RBSI |
| 8C196 | Other | ID | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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