Organization
ALLIANCE MEDICAL GROUP, LLC
Active
Other names
Primary Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID PETERMAN MD (PRESIDENT)
(208) 955-6522
Entity
Organization
Contact information
Practice address
6052 W STATE ST, BOISE, ID 83703-2739
(208) 344-7799
(208) 344-7152
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
12/16/2008
Last updated
02/18/2011
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