Organization
CLINIC AT EAGLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHE ALKIRE CRNP (OWNER)
(208) 939-2273
Entity
Organization
Contact information
Practice address
600 E STATE ST, SUITE 200, EAGLE, ID 83616-6081
(208) 939-2237
(208) 939-5888
Mailing address
PO BOX 9589, BOISE, ID 83707-4589
(208) 472-8112
(208) 472-8172
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010135253
BLUE SHIELD
ID
01
—
8G171
BLUE CROSS
ID
Enumeration date
03/29/2006
Last updated
07/27/2010
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