Organization
TWO RIVERS MEDICAL CLINIC, PA
Active
Organization
TWO RIVERS MEDICAL CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONY EDMONDSON (CLINIC ADMINISTRATOR)
(208) 549-0211
Entity
Organization
Contact information
Practice address
683 E 3RD ST, WEISER, ID 83672-2248
(208) 549-0211
(208) 549-0104
Mailing address
PO BOX 871, WEISER, ID 83672-0001
(208) 549-0211
(208) 549-0104
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002756300
—
ID
05
—
002756600
—
ID
05
—
1376662486
—
ID
05
—
805040300
—
ID
Enumeration date
03/28/2007
Last updated
04/12/2016
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