| NPI | 1083487706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMELIA MURPHY Medical Staff COO Rdinator 208-232-7862 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2023-11-03 |
| Last Update Date | 2025-04-21 |