# ST BENEDICTS FMC PHYSICIAN ASSISTANTS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ST BENEDICTS FAMILY MEDICAL CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1700053774
- **Legal business name:** ST BENEDICTS FAMILY MEDICAL CENTER
- **Authorized official:** ALAN STEVENSON (ADMINISTRATOR)
- **Authorized official phone:** (208) 324-1122

## Contact information

- **Practice address:** 709 N LINCOLN AVE, JEROME, ID 83338-1851
- **Practice address phone:** (208) 324-4301
- **Practice address fax:** (208) 324-9529
- **Mailing address:** 709 N LINCOLN AVE, JEROME, ID 83338-1851
- **Mailing address phone:** (208) 324-4301
- **Mailing address fax:** (208) 324-9529

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 08 | ID | Yes |

## Other

- **Enumeration date:** 05/09/2008
- **Last updated:** 05/09/2008