Organization
PHYSICIANS CLINIC PLLC
Active
Other names
MCMILLAN MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CORINNE K CHASTAIN (OFFICE MANAGER)
(208) 375-0500
Entity
Organization
Contact information
Practice address
4750 N FIVE MILE RD, BOISE, ID 83713-2715
(208) 375-0500
(208) 375-4310
Mailing address
4750 N FIVE MILE RD, BOISE, ID 83713-2715
(208) 375-0500
(208) 375-4310
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8D319
BLUE CROSS
ID
Enumeration date
10/11/2006
Last updated
08/22/2020
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