Organization
PRIMARY CARE SPECIALISTS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK L MANSFIELD MD (PRESIDENT)
(208) 234-2300
Entity
Organization
Contact information
Practice address
110 VISTA DRIVE, POCATELLO, ID 83201
(208) 234-2300
(208) 234-0026
Mailing address
110 VISTA DRIVE, POCATELLO, ID 83201
(208) 234-2300
(208) 234-0026
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805105400
—
ID
Enumeration date
08/05/2006
Last updated
09/18/2012
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