| NPI | 1972545762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY MOORE CEO 208-459-3718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 2084N0400X Psychiatry & Neurology Neurology | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2008-08-12 |