Basic Information
| Provider Information | |||||||||
| NPI: | 1477689198 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH IDAHO FAMILY CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 927 E POLSTON AVE | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838549811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086643313 | ||||||||
| FaxNumber: | 2086642793 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 E POLSTON AVE | ||||||||
| Address2: | |||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838549049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087739113 | ||||||||
| FaxNumber: | 2087734911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2086643313 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.