Basic Information
| Provider Information | |||||||||
| NPI: | 1790875920 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAGIC VALLEY WOMENS HEALTH CLINIC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 ADDISON AVE WEST | ||||||||
| Address2: | SUITE #210 | ||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087332882 | ||||||||
| FaxNumber: | 2087344143 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 ADDISON AVE WEST | ||||||||
| Address2: | SUITE #210 | ||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087332882 | ||||||||
| FaxNumber: | 2087344143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | ELDREDGE | ||||||||
| AuthorizedOfficialFirstName: | KARIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2087332882 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.