| Clover Creek Medical | |
|
175 North Main Street Bloomington ID 83223-8322 | |
| (801) 362-0157 | |
| (801) 362-0157 |
| Full Name | Clover Creek Medical |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 175 North Main Street, Bloomington, Idaho |
| Authorized Official Name and Position | Brittany Strong (CEO) |
| Authorized Official Contact | 8013620157 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clover Creek Medical Po Box 208 Bloomington ID 83223-0208 Ph: (801) 362-0157 | Clover Creek Medical 175 North Main Street Bloomington ID 83223-8322 Ph: (801) 362-0157 |
| NPI Number | 1073031118 |
|---|---|
| Provider Enumeration Date | 09/08/2017 |
| Last Update Date | 09/08/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073031118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |