| State Of Idaho | |
|
1660 11th Ave N Nampa ID 83687-5000 | |
| (208) 442-2812 | |
| (208) 467-5978 |
| Full Name | State Of Idaho |
|---|---|
| Speciality | Family Medicine |
| Location | 1660 11th Ave N, Nampa, Idaho |
| Authorized Official Name and Position | Sue Broetje (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Contact | 2084422812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Idaho 1660 11th Ave N Nampa ID 83687-5000 Ph: (208) 442-2812 | State Of Idaho 1660 11th Ave N Nampa ID 83687-5000 Ph: (208) 442-2812 |
| NPI Number | 1265558019 |
|---|---|
| Provider Enumeration Date | 03/22/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265558019 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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