| NPI | 1922152537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY GEYMAN Manager 208-267-1788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M8544) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2023-12-18 |