# MACHEN FAMILY MEDICINE, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MACHEN FAMILY MEDICINE, PC
- **Other names:** SHANE G MACHEN, DO
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1013204445
- **Legal business name:** MACHEN FAMILY MEDICINE, PC
- **Authorized official:** SHANE G MACHEN DO (OWNER)
- **Authorized official phone:** (208) 522-7666

## Contact information

- **Practice address:** 1995 E 17TH ST STE A, IDAHO FALLS, ID 83404-6493
- **Practice address phone:** (208) 522-7666
- **Practice address fax:** (208) 524-2821
- **Mailing address:** 1995 E 17TH ST STE A, IDAHO FALLS, ID 83404-6493
- **Mailing address phone:** (208) 522-7666
- **Mailing address fax:** (208) 524-2821

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | O-0611 | ID | Yes |

## Other

- **Enumeration date:** 07/06/2011
- **Last updated:** 04/26/2012