Organization
COMMUNITY CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN L PETERSON (CEO)
(208) 525-8448
Entity
Organization
Contact information
Practice address
1595 YELLOWSTONE AVE, POCATELLO, ID 83201
(208) 233-0032
Mailing address
1595 YELLOWSTONE AVE, POCATELLO, ID 83201
(208) 233-0032
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
04/02/2008
Last updated
08/12/2010
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