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Organization

MAGIC VALLEY MEDICINE PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SAMUEL H BARKER (SOLE MEMBER)
(208) 734-0000
Entity
Organization

Contact information

Practice address
844 WASHINGTON ST N STE 400, TWIN FALLS, ID 83301-3874
(208) 734-0000
(208) 735-5053
Mailing address
844 WASHINGTON ST N STE 400, TWIN FALLS, ID 83301-3874
(208) 734-0000
(208) 735-5053

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
363LF0000X
Family Nurse Practitioner
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1174939383
ID
01
7369300001
MEDICARE DME
Enumeration date
07/08/2014
Last updated
07/11/2016
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