| NPI | 1407505415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA L PIKE Admin 208-957-5532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2022-07-19 |