Organization
IDAHO FALLS CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTINE C. CLARK (ADMINISTRATOR)
(208) 522-7310
Entity
Organization
Contact information
Practice address
2001 S WOODRUFF AVE, SUITE #15, IDAHO FALLS, ID 83404-6374
(208) 522-7310
(208) 524-0559
Mailing address
2001 S WOODRUFF AVE, SUITE #15, IDAHO FALLS, ID 83404-6374
(208) 522-7310
(208) 524-0559
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88468
BLUE CROSS
ID
01
—
I843154
TRICARE
ID
01
—
P9154
RR MEDICARE
ID
Enumeration date
06/18/2006
Last updated
08/22/2020
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