Organization
PHYSICIAN CENTER , A PROFESSIONAL COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL J MOFFITT M.D. (PHYSICIAN)
(208) 814-8000
Entity
Organization
Contact information
Practice address
775 POLE LINE RD W, SUITES 105 & 111, TWIN FALLS, ID 83301-5814
(208) 814-8000
(208) 733-9402
Mailing address
775 POLE LINE RD W, SUITES 105 & 111, TWIN FALLS, ID 83301-5814
(208) 814-8000
(208) 733-9402
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
2083X0100X
Occupational Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002746900
—
ID
01
—
CD3787
RR MEDICARE
ID
Enumeration date
06/09/2006
Last updated
03/09/2013
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