| Organization Name: | GEM FAMILY PRACTICE, INC |
| NPI Number: | 1205052198 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNICE M CORDOVA (PRESIDENT) |
| Mailing Address: | 1108 S Washington Ave Emmett |
| State: | ID US |
| Postal Code: | 836173535 |
| Phone Number: | 2083653455 |
| Fax Number: | 2083653422 |
| NPI Enumeration Date: | 04/18/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | PA 281 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |