| NPI | 1962916304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEOFFREY NEIL HICKS Provider 208-733-4444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-180) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: ID O-180) |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2018-02-14 |