Organization
NORTH CANYON MOUNTAIN HOME CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM POWERS (CEO)
(208) 934-8765
Entity
Organization
Contact information
Practice address
840 N 4TH E, MOUNTAIN HOME, ID 83647-2166
(208) 934-8829
(208) 934-4874
Mailing address
267 N CANYON DR, GOODING, ID 83330-5500
(208) 934-4433
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184932584
—
ID
Enumeration date
08/13/2018
Last updated
08/13/2018
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