| NPI | 1760276646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER TUELLER Corporate Secretary 208-207-2726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2025-04-07 |
| Last Update Date | 2026-08-17 |