Organization
SHH MEDICAL GROUP IDAHO, LLC
Active
Other names
AUTUMN RIDGE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
JASON FLETCHER (PRESIDENT)
(208) 376-7298
Entity
Organization
Contact information
Practice address
3751 N CLOVERDALE RD, BOISE, ID 83713-3610
(208) 321-5073
(208) 376-0269
Mailing address
PO BOX 1176, MERIDIAN, ID 83680-1176
(208) 376-7298
(208) 377-8310
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
07/03/2019
Last updated
07/03/2019
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