NPI age
16 years
Enumerated 2009-06-12
Across 55 active clinic/center providers in Idaho.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 11043901 | MEDICARE PTAN |
Multi-provider organization. 1 individual provider on file at this primary address.
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