Organization
I CARE MEDICAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER RICKELL WILLMORE MPAS, PAC (OWNER)
(208) 624-4402
Entity
Organization
Contact information
Practice address
430 N BRIDGE ST, SAINT ANTHONY, ID 83445-1425
(208) 624-4402
(208) 624-4409
Mailing address
430 N BRIDGE ST, SAINT ANTHONY, ID 83445-1425
(208) 624-4402
(208) 624-4409
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 519
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807122700
—
ID
Enumeration date
10/18/2012
Last updated
04/04/2013
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