Southern Idaho Medicine Pllc

NPI #1861105694 in Jerome, Idaho

Provider Information

NPI Number: 1861105694
Entity Type: Organization
Organization Name: Southern Idaho Medicine Pllc
Primary Specialty: Clinic/Center
Enumeration Date: Dec 26, 2022
Last Updated: Dec 26, 2022

Practice Location

Address: 207 E MAIN ST
City: Jerome
State: Idaho
ZIP Code: 83338-2334
Phone: (208) 308-7738

Authorized Official

Name: JESSICCA MARIE CRISMOR, FNP
Title: OWNER
Phone: (208) 308-7738

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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