Organization
LOST RIVERS MEDICAL CENTER
Active
Other names
MACKAY CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD HUERTA (CEO)
(208) 527-8206
Entity
Organization
Contact information
Practice address
313 HWY 93, MACKAY, ID 83251
(208) 588-2993
(208) 588-2997
Mailing address
PO BOX 815, ARCO, ID 83213-0815
(208) 527-8206
(208) 527-3616
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804212900
—
ID
Enumeration date
07/20/2006
Last updated
05/01/2017
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