# LOST RIVERS MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MACKAY CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760402663
- **Authorized official:** MR. BRAD HUERTA (CEO)
- **Authorized official phone:** (208) 527-8206

## Contact information

- **Practice address:** 313 HWY 93, MACKAY, ID 83251
- **Practice address phone:** (208) 588-2993
- **Practice address fax:** (208) 588-2997
- **Mailing address:** PO BOX 815, ARCO, ID 83213-0815
- **Mailing address phone:** (208) 527-8206
- **Mailing address fax:** (208) 527-3616

## Taxonomy

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

## Other

- **Enumeration date:** 07/20/2006
- **Last updated:** 05/01/2017