Organization
GEM STATE FAMILY HEALTH CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUNA J ZODROW (OFFICE MGR)
(208) 733-2885
Entity
Organization
Contact information
Practice address
496 SHOUP AVE W STE E, TWIN FALLS, ID 83301-5043
(208) 733-2885
(208) 734-3352
Mailing address
496 SHOUP AVE W STE E, TWIN FALLS, ID 83301-5043
(208) 733-2885
(208) 734-3352
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP767A
STATE LICENSE
ID
Enumeration date
08/07/2018
Last updated
08/07/2018
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