Organization
BLACKFOOT MEDICAL CLINIC SURGEONS
Active
Parent organization
BLACKFOOT MEDICAL CLINIC INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLACKFOOT MEDICAL CLINIC INC
Authorized official
KERRY CASPERSON (ADMINISTRATOR)
(208) 785-2600
Entity
Organization
Contact information
Practice address
1441 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 785-2600
Mailing address
1441 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 785-2600
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
10/25/2010
Last updated
10/25/2010
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