| NPI | 1992895866 |
|---|---|
| Other Name | STATE STREET IMMEDIATE MEDICAL CARE |
| Entity Type | Organization |
| Authorized Contact | CORINNE K CHASTAIN Office Manager 208-375-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2020-08-22 |