# SPECIALIZED FAMILY MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124197702
- **Authorized official:** JORDAN L BAILEY MD (PHYSICIAN OWNER)
- **Authorized official phone:** (208) 269-7147

## Contact information

- **Practice address:** 151 N 4TH AVE, SUITE B, POCATELLO, ID 83201-6300
- **Practice address phone:** (208) 369-7147
- **Practice address fax:** (208) 416-6522
- **Mailing address:** 151 N 4TH AVE, SUITE B, POCATELLO, ID 83201-6300
- **Mailing address phone:** (208) 369-7147
- **Mailing address fax:** (208) 416-6522

## Taxonomy

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

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 07/21/2022