| NPI | 1457698987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUSTIN C GILLETTE Owner 208-881-5222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: ID O-0518) |
| Additional Taxonomies | 261Q00000X (Licence: ID O-0518) |
| 261QR1100X Clinic/Center, Research (Licence: ID O-0518) | |
| 261QU0200X Clinic/Center, Urgent Care (Licence: ID O-0518) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2013-01-03 |
| Last Update Date | 2019-11-19 |