| NPI | 1164044962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORBIN BUNNAGE Provider/Owner 208-542-9111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 261QU0200X Clinic/Center, Urgent Care | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2025-04-01 |