| Northridge Internal Medicine, Pllc | |
|
36 Professional Plz Ste-102 Rexburg ID 83440-2049 | |
| (208) 656-8456 | |
| (208) 656-8444 |
| Full Name | Northridge Internal Medicine, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 36 Professional Plz, Rexburg, Idaho |
| Authorized Official Name and Position | Rodney Bates (MEMBER) |
| Authorized Official Contact | 2086568456 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northridge Internal Medicine, Pllc 36 Professional Plz Ste-102 Rexburg ID 83440-2049 Ph: (208) 656-8456 | Northridge Internal Medicine, Pllc 36 Professional Plz Ste-102 Rexburg ID 83440-2049 Ph: (208) 656-8456 |
| NPI Number | 1033394713 |
|---|---|
| Provider Enumeration Date | 12/31/2007 |
| Last Update Date | 02/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033394713 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | O0359 (Idaho) | Primary |
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