NPI age
20 years
Enumerated 2005-10-06
Across 1691 active family medicine providers in Idaho.
1 secondary location on file with NPPES.
20 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | MAVIS 1075 | |
| 01 (ID) | 000010006427 | BLUE SHIELD |
| 01 (ID) | C188 | BLUE CROSS & TRUE BLUE |
Multi-provider organization. 20 individual providers on file at this primary address. Plus 1 secondary practice location.
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