institution
Mountain State Family Medicine, Pc
Primary Care Clinic/Center in Grangeville, Idaho
NPI 1710917612

Mountain State Family Medicine, Pc is a Primary Care Clinic/Center based in Grangeville, ID and is specialized in Primary Care. Mountain State Family Medicine, Pc practices in Grangeville, ID. The NPI Number for Mountain State Family Medicine, Pc is 1710917612 and holds a License No. (Idaho).

The current practice location address for Mountain State Family Medicine, Pc is 610 Nw 2Nd St, Grangeville, ID and can be reached out via phone at 208-983-5120 and via fax at 208-983-5404.

Location: 610 Nw 2Nd St, Grangeville, ID, 83530-1244
institution
Provider Profile Details
NPI Number
1710917612
Provider Name
Mountain State Family Medicine, Pc
Credential
Provider Entity Type
Organization
Address
610 Nw 2Nd St, Grangeville, ID, 83530-1244
Phone Number
208-983-5120
Fax Number
208-983-5404
Provider Enumeration Date
07/04/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
000010017999 01 ID REGENCE BLUE SHIELD
8M434 01 ID BLUE CROSS OF IDAHO
institution
Provider Business Practice Location Address Details
Address
610 Nw 2Nd St
City
State
Zip
83530-1244
Phone Number
208-983-5120
Fax Number
208-983-5404
person
Provider Business Mailing Address Details
Address
610 Nw 2Nd St
City
State
Zip
83530-1244
Phone Number
208-983-5120
Fax Number
208-983-5404
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Primary Care
Taxonomy
License No.
()
Definition
Definition to come...
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