| Shane G Machen, Do | |
|
1995 E 17th St Ste A Idaho Falls ID 83404-6493 | |
| (208) 522-7666 | |
| (208) 524-2821 |
| Full Name | Shane G Machen, Do |
|---|---|
| Speciality | Family Medicine |
| Location | 1995 E 17th St Ste A, Idaho Falls, Idaho |
| Authorized Official Name and Position | Shane G Machen (OWNER) |
| Authorized Official Contact | 2085227666 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shane G Machen, Do 1995 E 17th St Ste A Idaho Falls ID 83404-6493 Ph: (208) 522-7666 | Shane G Machen, Do 1995 E 17th St Ste A Idaho Falls ID 83404-6493 Ph: (208) 522-7666 |
| NPI Number | 1013204445 |
|---|---|
| Provider Enumeration Date | 07/06/2011 |
| Last Update Date | 04/26/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013204445 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | O-0611 (Idaho) | Primary |
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