St Benedicts Fmc Physician Assistants

NPI #1700053774 in Jerome, Idaho

Provider Information

NPI Number: 1700053774
Entity Type: Organization
Organization Name: St Benedicts Fmc Physician Assistants
Subpart: Yes (part of a larger organization)
Parent Organization: ST BENEDICTS FAMILY MEDICAL CENTER
Primary Specialty: Physician Assistant
Enumeration Date: May 9, 2008
Last Updated: May 9, 2008

Practice Location

Address: 709 N LINCOLN AVE
City: Jerome
State: Idaho
ZIP Code: 83338-1851
Phone: (208) 324-4301

Authorized Official

Name: ALAN STEVENSON
Title: ADMINISTRATOR
Phone: (208) 324-1122

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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