| Full Name | |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 167 E 1st S, Rigby, Idaho |
| Authorized Official Name and Position | Ned W Hillyard (CHIEF COMPLIANCE OFFICER) |
| Authorized Official Contact | 2087094571 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
167 E 1st S Rigby ID 83442-1401 Ph: (208) 745-8747 | 167 E 1st S Rigby ID 83442-1401 Ph: (208) 745-8747 |
| NPI Number | 1447840038 |
|---|---|
| Provider Enumeration Date | 01/19/2021 |
| Last Update Date | 11/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447840038 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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