Basic Information
| Provider Information | |||||||||
| NPI: | 1376504498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRICE-MILLER | ||||||||
| FirstName: | MARCIA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5999 W STATE ST STE B | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837035059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088415965 | ||||||||
| FaxNumber: | 2089395888 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 COTTONWOOD CT | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | EAGLE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836166545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088415965 | ||||||||
| FaxNumber: | 2089395888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 02/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M6967 | ID | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000010140318 | 01 | ID | BLUE SHIELD | OTHER | 51276 | 01 | ID | BLUE CROSS | OTHER | 003874400 | 05 | ID | MEDICAID |