| NPI | 1336415769 |
|---|---|
| Doing Business As | MEDICARE & FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | BRANDY FLEGEL Chief Operating Officer 208-419-0593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP1660A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1660A) |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: ID M-10400) | |
| 207Q00000X Family Medicine (Licence: ID M-10400) | |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: ID NP1660A) | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2017-04-28 |