| NPI | 1134621436 |
|---|---|
| Doing Business As | BINGHAM HEALTHCARE SPECIALTY CLINIC - 4TH ST |
| Entity Type | Organization |
| Authorized Contact | JACOB ERICKSON CEO 208-785-3801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2019-02-26 |