| Psc Radiate | |
|
3040 E 17th St Ste A Ammon ID 83406-6760 | |
| (208) 557-0998 | |
| Not Available |
| Full Name | Psc Radiate |
|---|---|
| Speciality | Family Medicine |
| Location | 3040 E 17th St Ste A, Ammon, Idaho |
| Authorized Official Name and Position | Katie Davenport (BILLING) |
| Authorized Official Contact | 2085202636 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Psc Radiate 3040 E 17th St Ste A Ammon ID 83406-6760 Ph: (208) 557-0998 | Psc Radiate 3040 E 17th St Ste A Ammon ID 83406-6760 Ph: (208) 557-0998 |
| NPI Number | 1235472895 |
|---|---|
| Provider Enumeration Date | 04/02/2013 |
| Last Update Date | 04/02/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235472895 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M3801 (Idaho) | Primary |
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