Organization
POCATELLO FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE JOHNSON (OFFICE MANAGER)
(208) 282-4421
Entity
Organization
Contact information
Practice address
465 MEMORIAL DRIVE, POCATELLO, ID 83201-4008
(208) 282-4700
(208) 282-4696
Mailing address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 282-4700
(208) 282-4696
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
NP-1199A
ID
Other
Enumeration date
08/07/2012
Last updated
08/07/2012
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