# STATE OF IDAHO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DHW ISSH GROUP PHYSICIANS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265558019
- **Authorized official:** SUE BROETJE (ADMINISTRATIVE DIRECTOR)
- **Authorized official phone:** (208) 442-2812

## Contact information

- **Practice address:** 1660 11TH AVE N, NAMPA, ID 83687-5000
- **Practice address phone:** (208) 442-2812
- **Practice address fax:** (208) 467-5978
- **Mailing address:** 1660 11TH AVE N, NAMPA, ID 83687-5000
- **Mailing address phone:** (208) 442-2812
- **Mailing address fax:** (208) 467-5978

## Taxonomy

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

## Other

- **Enumeration date:** 03/22/2007
- **Last updated:** 08/22/2020