| NPI | 1154320752 |
|---|---|
| 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 | 207Q00000X Family Medicine (Licence: ID M7806) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2020-08-17 |