Organization
PHYSICIAN MANAGEMENT SERVICES OF IDAHO, LLC
Active
Parent organization
VAXCARE CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
VAXCARE CORPORATION
Authorized official
BRETT KENEFICK (PRESIDENT)
(888) 829-8550
Entity
Organization
Contact information
Practice address
113 S APPLE ST, SHOSHONE, ID 83352-5287
(888) 829-8550
Mailing address
3113 LAWTON RD, ORLANDO, FL 32803-3531
(888) 829-8550
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/11/2022
Last updated
01/11/2022
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