Organization
IDAHO PHYSICIANS CLINIC
Active
Organization
IDAHO PHYSICIANS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS KRAML (CEO)
(208) 785-3804
Entity
Organization
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-3800
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-3800
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
36
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010137702
BLUE SHIELD PROVIDER #
ID
01
—
8F496
BLUE CROSS PROVIDER #
ID
Enumeration date
01/20/2006
Last updated
08/22/2020
Update your record
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