| NPI | 1841603768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN KEITH CROWNOVER Owner/President/Physician 208-895-0050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: ID M11819) |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2023-09-12 |