Basic Information
| Provider Information | |||||||||
| NPI: | 1235306861 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCCALL MEDICAL CLINICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 STATE ST | ||||||||
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| City: | MCCALL | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836383704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086344061 | ||||||||
| FaxNumber: | 2086347112 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 FOREST ST | ||||||||
| Address2: | |||||||||
| City: | MCCALL | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836385256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086341776 | ||||||||
| FaxNumber: | 2086343873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 02/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | GROENIG | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2086344061 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MCCALL MEMORIAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC0050X | Y | Ambulatory Health Care Facilities | Clinic/Center | Critical Access Hospital |
No ID Information.