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Organization
PHYSICIANS CLINIC PLLC
Active
Organization
PHYSICIANS CLINIC PLLC
Active
Other names
STATE STREET IMMEDIATE MEDICAL CARE
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CORINNE K CHASTAIN (OFFICE MANAGER)
(208) 375-0500
Entity
Organization
Contact information
Practice address
4902 W STATE ST, BOISE, ID 83703-3326
(208) 853-3100
(208) 853-3120
Mailing address
4902 W STATE ST, BOISE, ID 83703-3326
(208) 853-3100
(208) 853-3120
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
10/13/2006
Last updated
08/22/2020
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