| NPI | 1639713589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORBIN BUNNAGE Provider/Ower 208-542-9111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 261QX0100X Clinic/Center, Occupational Medicine |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2026-06-17 |