# PHYSICIAN CENTER A PROFESSIONAL COMPANY MID LEVEL

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

## Provider details

- **NPI number:** 1245414028
- **Authorized official:** MITCHELL J MOFFITT MD (PHYSICIAN)
- **Authorized official phone:** (208) 814-8000

## Contact information

- **Practice address:** 775 POLE LINE RD W, SUITE 105 & 111, TWIN FALLS, ID 83301-5814
- **Practice address phone:** (208) 814-8000
- **Practice address fax:** (208) 733-9402
- **Mailing address:** 775 POLE LINE RD W, SUITE 105 & 111, TWIN FALLS, ID 83301-5814
- **Mailing address phone:** (208) 814-8000
- **Mailing address fax:** (208) 733-9402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 12/28/2007
- **Last updated:** 03/09/2013