Organization
CORE MEDICINE IDAHO, LLC
Active
Other names
Core Medicine of Idaho
Organization subpart
No
Provider details
NPI number
Authorized official
SOPHIE RATH (MANANGER)
(208) 795-5090
Entity
Organization
Contact information
Practice address
4605 ENTERPRISE WAY, STE 101, CALDWELL, ID 83605-8360
(208) 353-7518
Mailing address
2667 E GALA CT STE 130, MERIDIAN, ID 83642-2788
(208) 795-5090
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295734796
—
ID
Enumeration date
11/01/2022
Last updated
01/16/2024
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