Organization
FALL RIVER MEDICAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUSTIN C GILLETTE MD (OWNER)
(208) 881-5222
Entity
Organization
Contact information
Practice address
21 WINN DR, REXBURG, ID 83440
(208) 881-5222
(877) 441-4715
Mailing address
21 WINN DR, REXBURG, ID 83440-5277
(208) 220-1057
(188) 851-2685
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
O-0518
ID
261QP2300X
Primary Care Clinic/Center
Primary
O-0518
ID
261QR1100X
Research Clinic/Center
O-0518
ID
261QU0200X
Urgent Care Clinic/Center
O-0518
ID
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083810287
NPI
ID
01
—
1972709103
NPI
ID
Enumeration date
01/03/2013
Last updated
11/19/2019
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