Payette Lakes Medical Clinic, PA
NPI #1922139468 in New Meadows, Idaho
Provider Information
- NPI Number
- 1922139468
- Entity Type
- Organization
- Organization Name
- Payette Lakes Medical Clinic, PA
- Primary Specialty
- Clinic/Center - Primary Care
- Enumeration Date
- Mar 8, 2007
- Last Updated
- Mar 17, 2008
Practice Location
- Address
- 320 VIRGINIA AVENUE
- City
- New Meadows
- State
- Idaho
- ZIP Code
- 83654
- Phone
- (208) 347-2146
Authorized Official
- Name
- JACQUELINE R BRUNS
- Title
- VP - PHYSICIAN SERVICES
- Phone
- (208) 634-4061
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Primary Care — Primary Care |
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