# PETRIE WHITE FAMILY MEDICINE OF IDAHO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Emmett Family Medicine and Direct Primary Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447629555
- **Authorized official:** MR. RYAN EARL WHITE CRNA (CLINIC ADMINISTRATOR)
- **Authorized official phone:** (208) 365-7131

## Contact information

- **Practice address:** 2001 E QUAIL RUN RD, EMMETT, ID 83617-5059
- **Practice address phone:** (208) 365-7131
- **Practice address fax:** (208) 365-4464
- **Mailing address:** 2001 E QUAIL RUN RD, EMMETT, ID 83617-5059
- **Mailing address phone:** (208) 365-7131
- **Mailing address fax:** (208) 365-4464

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | M7802 | ID | Yes |

## Other

- **Enumeration date:** 09/18/2015
- **Last updated:** 01/12/2016