# I CARE MEDICAL CLINIC PA

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

## Provider details

- **NPI number:** 1952654741
- **Authorized official:** JENNIFER RICKELL WILLMORE MPAS, PAC (OWNER)
- **Authorized official phone:** (208) 624-4402

## Contact information

- **Practice address:** 430 N BRIDGE ST, SAINT ANTHONY, ID 83445-1425
- **Practice address phone:** (208) 624-4402
- **Practice address fax:** (208) 624-4409
- **Mailing address:** 430 N BRIDGE ST, SAINT ANTHONY, ID 83445-1425
- **Mailing address phone:** (208) 624-4402
- **Mailing address fax:** (208) 624-4409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA 519 | ID | Yes |

## Other

- **Enumeration date:** 10/18/2012
- **Last updated:** 04/04/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 807122700 | — | ID |