Southeast Idaho Family Practice

NPI #1982759007 in Idaho Falls, Idaho

Provider Information

NPI Number: 1982759007
Entity Type: Organization
Organization Name: Southeast Idaho Family Practice
Primary Specialty: Family Medicine
Enumeration Date: Jan 25, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 2775 CHANNING WAY
City: Idaho Falls
State: Idaho
ZIP Code: 83404-7510
Phone: (208) 524-0133

Authorized Official

Name: CONNIE M BATES
Title: OFFICE MANAGER
Phone: (208) 524-6694

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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