Organization
BLACKFOOT MEDICAL CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY MILLER (BUSINESS OFFICE MANAGER)
(208) 785-2600
Entity
Organization
Contact information
Practice address
1441 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 785-2600
(208) 785-8185
Mailing address
1441 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 785-2600
(208) 785-8185
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002333900
—
ID
Enumeration date
07/05/2006
Last updated
07/19/2012
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