| NPI | 1578505335 |
|---|---|
| Other Name | POCATELLO (ISU) FAMILY MEDICINE |
| Entity Type | Organization |
| Authorized Contact | JOHNATHAN WILKER VP Finance & CFO 208-239-1020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: ID H12) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-08-22 |