| Dominican Health Services | |
|
1118 Nw 16th St Fruitland ID 83619-2271 | |
| (208) 452-6851 | |
| (541) 881-7156 |
| Full Name | Dominican Health Services |
|---|---|
| Speciality | Family Medicine |
| Location | 1118 Nw 16th St, Fruitland, Idaho |
| Authorized Official Name and Position | Mark Dalley (CEO) |
| Authorized Official Contact | 5418817020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dominican Health Services 351 Sw 9th St Ontario OR 97914-2639 Ph: (541) 881-7020 | Dominican Health Services 1118 Nw 16th St Fruitland ID 83619-2271 Ph: (208) 452-6851 |
| NPI Number | 1750372579 |
|---|---|
| Provider Enumeration Date | 11/01/2005 |
| Last Update Date | 06/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750372579 | NPI | - | NPPES |
| 134054 | Medicaid | OR | |
| E8340 | Other | ID | BCID GROUP |
| 8053332-00 | Medicaid | ID | |
| X-009702000 | Other | OR | BLUE CROSS OF OREGON |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 00189759321500 (Oregon) | Primary |
Saint Alphonsus Medical Group Dominican Health Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1118 Nw 16th St, Suite A, Fruitland, ID 83619 Phone: 208-452-6851 | |
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