# FAMILY MEDICINE HUB PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blair Family Medicine, Blair Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134620107
- **Authorized official:** SHELLY CAMERON (PRACTICE MANAGER)
- **Authorized official phone:** (208) 357-4633

## Contact information

- **Practice address:** 2001 S WOODRUFF AVE STE 15B, IDAHO FALLS, ID 83404-6372
- **Practice address phone:** (208) 357-4633
- **Practice address fax:** (208) 419-0690
- **Mailing address:** 2001 S WOODRUFF AVE STE 15B, IDAHO FALLS, ID 83404-6372
- **Mailing address phone:** (208) 357-4633
- **Mailing address fax:** (208) 419-0690

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/26/2018
- **Last updated:** 11/12/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1629128483 | — | ID |