| NPI | 1629392154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC KOELSCH Executive Director 208-676-0145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2012-03-22 |