| Physician Center , A Professional Company | |
|
775 Pole Line Rd W Suites 105 & 111 Twin Falls ID 83301-5814 | |
| (208) 814-8000 | |
| (208) 733-9402 |
| Full Name | Physician Center , A Professional Company |
|---|---|
| Speciality | Family Medicine |
| Location | 775 Pole Line Rd W, Twin Falls, Idaho |
| Authorized Official Name and Position | Mitchell J Moffitt (PHYSICIAN) |
| Authorized Official Contact | 2088148000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Physician Center , A Professional Company 775 Pole Line Rd W Suites 105 & 111 Twin Falls ID 83301-5814 Ph: (208) 814-8000 | Physician Center , A Professional Company 775 Pole Line Rd W Suites 105 & 111 Twin Falls ID 83301-5814 Ph: (208) 814-8000 |
| NPI Number | 1508807926 |
|---|---|
| Provider Enumeration Date | 06/09/2006 |
| Last Update Date | 03/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508807926 | NPI | - | NPPES |
| CD3787 | Other | ID | RR MEDICARE |
| 002746900 | Medicaid | ID |
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Blue Lakes Gastroenterology, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 775 Pole Line Rd W, Suite 203, Twin Falls, ID 83301 Phone: 208-814-8300 Fax: 208-733-8970 | |
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