# SENIOR DOC IDAHO PC

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

## Provider details

- **NPI number:** 1750961637
- **Authorized official:** JOHN GEISS (OWNER/DOCTOR)
- **Authorized official phone:** (855) 434-7763

## Contact information

- **Practice address:** 4301 GARRITY BLVD STE 103, NAMPA, ID 83687-9222
- **Practice address phone:** (855) 434-7763
- **Practice address fax:** (949) 281-5550
- **Mailing address:** 5 HUTTON CENTRE DR STE 950, SANTA ANA, CA 92707-8714
- **Mailing address phone:** (558) 434-7763

## Taxonomy

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

## Other

- **Enumeration date:** 04/13/2021
- **Last updated:** 01/13/2025