Organization
MANGUM PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEREDITH KAYE MANGUM FNP-C (OWNER)
(801) 793-8124
Entity
Organization
Contact information
Practice address
3046 S BOWN WAY, BOISE, ID 83706-5499
(801) 793-8124
Mailing address
608 S PHILLIPPI ST, BOISE, ID 83705-1160
(801) 793-8124
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/11/2021
Last updated
09/11/2021
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