Physician Management Services of Idaho, LLC

NPI #1215688346 in Shoshone, Idaho

Provider Information

NPI Number: 1215688346
Entity Type: Organization
Organization Name: Physician Management Services of Idaho, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: VAXCARE CORPORATION
Primary Specialty: Family Medicine
Enumeration Date: Jan 11, 2022
Last Updated: Jan 11, 2022

Practice Location

Address: 113 S APPLE ST
City: Shoshone
State: Idaho
ZIP Code: 83352-5287
Phone: (888) 829-8550

Authorized Official

Name: BRETT KENEFICK
Title: PRESIDENT
Phone: (888) 829-8550

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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