# FAMILY MEDICINE & MEDICINE

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

## Provider details

- **NPI number:** 1194136515
- **Authorized official:** MRS. NANETTE FORD P.A.-C (PRESIDENT)
- **Authorized official phone:** (208) 725-0900

## Contact information

- **Practice address:** 380 WASHINGTON AVE, SUITE 204, KETCHUM, ID 83340-1575
- **Practice address phone:** (208) 725-0900
- **Practice address fax:** (208) 725-0901
- **Mailing address:** PO BOX 1575, KETCHUM, ID 83340-1575
- **Mailing address phone:** (208) 725-0900
- **Mailing address fax:** (208) 725-0901

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA-126 | ID | Yes |

## Other

- **Enumeration date:** 05/20/2014
- **Last updated:** 05/20/2014