# COMMUNITY CARE POCATELLO PLLC

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

## Provider details

- **NPI number:** 1265714760
- **Authorized official:** DEREK CAMPBELL D.O. (MEMBER)
- **Authorized official phone:** (208) 233-0032

## Contact information

- **Practice address:** 1595 YELLOWSTONE AVE, POCATELLO, ID 83201-4203
- **Practice address phone:** (208) 233-0032
- **Practice address fax:** (208) 237-9171
- **Mailing address:** 1595 YELLOWSTONE AVE, POCATELLO, ID 83201-4203
- **Mailing address phone:** (208) 233-0032
- **Mailing address fax:** (208) 237-9171

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/12/2011
- **Last updated:** 09/12/2011