Organization
JORDAN RIDGE FAMILY MEDICINE LLC
Active
Other names
Mobile Unit-Idaho
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY CASTILLO MANAGER (MANAGER)
(702) 480-2550
Entity
Organization
Contact information
Practice address
322 E FRONT ST, BOISE, ID 83702-7374
(385) 274-3959
(385) 274-3970
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 480-2550
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
01/10/2023
Last updated
01/10/2023
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