Organization
FREMONT FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD K ELLSWORTH M.D. (DOCTOR/OWNER)
(208) 680-2716
Entity
Organization
Contact information
Practice address
30 W MAIN ST, SAINT ANTHONY, ID 83445-2113
(208) 680-2716
Mailing address
30 W MAIN ST, SAINT ANTHONY, ID 83445-2113
(208) 680-2716
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
M-11978
ID
Other
Enumeration date
11/02/2015
Last updated
11/02/2015
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