| Organization Name: | FPC PLLC |
| NPI Number: | 1417357534 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SCOTT DAVID THOMAS (OWNER) |
| Mailing Address: | 852 Valley Centre Dr Driggs |
| State: | ID US |
| Postal Code: | 834225005 |
| Phone Number: | 2083544757 |
| Fax Number: | 2083544759 |
| NPI Enumeration Date: | 08/26/2014 |
| NPI Last Update Date: | 08/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | M-7462 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |