Organization
1ST CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN L. TORQUATO MD (CONTRACT PHYSICIAN)
(208) 772-7850
Entity
Organization
Contact information
Practice address
265 W PRAIRIE SHOPPING CTR, HAYDEN, ID 83835-9855
(208) 772-7850
(208) 772-2313
Mailing address
265 W PRAIRIE SHOPPING CTR, HAYDEN, ID 83835-9855
(208) 772-7850
(208) 772-2313
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
C158693 INC.STATEID
ID
Other
Enumeration date
11/13/2008
Last updated
11/13/2008
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