| Organization Name: | IDAHO PHYSICIANS CLINIC |
| NPI Number: | 1114907532 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LOUIS KRAML (CEO) |
| Mailing Address: | 98 Poplar St Blackfoot |
| State: | ID US |
| Postal Code: | 832211758 |
| Phone Number: | 2087853800 |
| Fax Number: | |
| NPI Enumeration Date: | 01/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 36 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |