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Organization

PAYETTE LAKES MEDICAL CLINIC, PA

Active
Other names
Meadows Valley Medical Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
JACQUELINE R BRUNS (VP - PHYSICIAN SERVICES)
(208) 634-4061
Entity
Organization

Contact information

Practice address
320 VIRGINIA AVENUE, NEW MEADOWS, ID 83654
(208) 347-2146
(208) 347-2147
Mailing address
P O BOX 1047, MCCALL, ID 83638-1047
(208) 347-2146
(208) 347-2147

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010006721
BS
ID
01
28340
BC
ID
Enumeration date
03/08/2007
Last updated
03/17/2008
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