Payette Lakes Medical Clinic, PA

NPI #1881725331 in Council, Idaho

Provider Information

NPI Number
1881725331
Entity Type
Organization
Organization Name
Payette Lakes Medical Clinic, PA
Subpart
Yes (part of a larger organization)
Parent Organization
PAYETTE LAKES MEDICAL CLINIC, PA
Primary Specialty
Clinic/Center - Primary Care
Enumeration Date
Mar 8, 2007
Last Updated
Mar 17, 2008

Practice Location

Address
101 COUNCIL AVENUE
Address 2
SUITE C
State
Idaho
ZIP Code
83612
Phone
(208) 253-4915

Authorized Official

Name
JACQUELINE R BRUNS
Title
VP - PHYSICIAN SERVICES
Phone
(208) 634-4061

Specialties & Taxonomy Codes

Specialty
Clinic/Center - Primary CarePrimary Care

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