Organization · Type 2 NPI

Payette Lakes Medical Clinic, PA

Primary Care Clinic/Center · Council, ID

NPI number 1881725331 Active

Practice location

101 Council Avenue, Suite C
Council, ID 83612

Call (208) 253-4915 Map

Fax (208) 253-4917

Mailing address

PO Box 1047
Mccall, ID 83638-1047

Specialties and licenses

Taxonomy	Code	License
Primary Care Clinic/Center Primary	261QP2300X	None listed

Primary Care Clinic/Center: Definition to come...

NPI record

NPI: 1881725331
Entity type: Organization (Type 2)
Issued: Mar 8, 2007
Last updated: Mar 17, 2008
Status: Active
Subpart: Yes of Payette Lakes Medical Clinic, PA

Other names

<unavail>
Council Mountain Medical Clinic · other name

Authorized official

Jacqueline R Bruns
VP - Physician Services
(208) 634-4061

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1881725331

Payette Lakes Medical Clinic, PA's National Provider Identifier is 1881725331, issued on Mar 8, 2007. The primary taxonomy on file is Primary Care Clinic/Center (261QP2300X), and the practice location is in Council, ID. The record was last updated on Mar 17, 2008.