Organization
ORANGE LLC.
Active
Other names
Medicare & Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDY FLEGEL (CHIEF OPERATING OFFICER)
(208) 419-0593
Entity
Organization
Contact information
Practice address
3652 WASHINGTON PKWY, IDAHO FALLS, ID 83404
(208) 419-0593
(208) 524-1222
Mailing address
3652 WASHINGTON PKWY, IDAHO FALLS, ID 83404
(208) 419-0593
(208) 524-1222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
M-10400
ID
261QM2500X
Medical Specialty Clinic/Center
M-10400
ID
261QM2500X
Medical Specialty Clinic/Center
NP1660A
ID
363LF0000X
Family Nurse Practitioner
NP-1660A
ID
363LF0000X
Family Nurse Practitioner
Primary
NP1660A
ID
Other
Enumeration date
03/29/2012
Last updated
04/28/2017
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