| Specialized Family Medicine | |
|
151 N 4th Ave Suite B Pocatello ID 83201-6300 | |
| (208) 369-7147 | |
| (208) 416-6522 |
| Full Name | Specialized Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 151 N 4th Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Jordan L Bailey (PHYSICIAN OWNER) |
| Authorized Official Contact | 2082697147 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Specialized Family Medicine 151 N 4th Ave Suite B Pocatello ID 83201-6300 Ph: (208) 369-7147 | Specialized Family Medicine 151 N 4th Ave Suite B Pocatello ID 83201-6300 Ph: (208) 369-7147 |
| NPI Number | 1124197702 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124197702 | NPI | - | NPPES |
| 8F991 | Other | ID | BLUE CROSS |
| 806364600 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Idaho) | Primary |
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