| Mountain State Family Medicine, Pc | |
|
610 Nw 2nd St Grangeville ID 83530-1244 | |
| (208) 983-5120 | |
| (208) 983-5404 |
| Full Name | Mountain State Family Medicine, Pc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 610 Nw 2nd St, Grangeville, Idaho |
| Authorized Official Name and Position | Leanne L Leblanc (PRESIDENT) |
| Authorized Official Contact | 2089835120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain State Family Medicine, Pc 610 Nw 2nd St Grangeville ID 83530-1244 Ph: (208) 983-5120 | Mountain State Family Medicine, Pc 610 Nw 2nd St Grangeville ID 83530-1244 Ph: (208) 983-5120 |
| NPI Number | 1710917612 |
|---|---|
| Provider Enumeration Date | 07/04/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710917612 | NPI | - | NPPES |
| 000010017999 | Other | ID | REGENCE BLUE SHIELD |
| 8M434 | Other | ID | BLUE CROSS OF IDAHO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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