Organization
MOUNTAIN STATE FAMILY MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEANNE L LEBLANC M.D. (PRESIDENT)
(208) 983-5120
Entity
Organization
Contact information
Practice address
610 NW 2ND ST, GRANGEVILLE, ID 83530-1244
(208) 983-5120
(208) 983-5404
Mailing address
610 NW 2ND ST, GRANGEVILLE, ID 83530-1244
(208) 983-5120
(208) 983-5404
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010017999
REGENCE BLUE SHIELD
ID
01
—
8M434
BLUE CROSS OF IDAHO
ID
Enumeration date
07/04/2006
Last updated
08/22/2020
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