Organization
MERCY PHYSICIAN GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. B LANNIE CHECKETTS CFO (CHIEF FINANCIAL OFFICER)
(208) 463-5531
Entity
Organization
Contact information
Practice address
1512 12TH AVE RD, NAMPA, ID 83686-6008
(208) 463-5000
(208) 463-5578
Mailing address
1512 12TH AVE RD, NAMPA, ID 83686-6008
(208) 463-5000
(208) 463-5578
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
—
207QA0505X
Adult Medicine Physician
Primary
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
208600000X
Surgery Physician
—
—
Other
Enumeration date
01/26/2007
Last updated
04/14/2008
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