Machen Family Medicine, PC
Family Medicine in Idaho Falls, ID. Organization (NPI-2).
NPI number1013204445
StatusActive
Last updated in NPPESApr 26, 2012
Details
- NPI
- 1013204445
- Entity type
- Organization (NPI-2)
- Legal business name
- Machen Family Medicine, PC
- Organization subpart
- Yes
- Enumeration date
- Jul 6, 2011
- Last updated
- Apr 26, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | O-0611 | ID | Yes |
Other names
- Shane G Machen, DO (Doing Business As)
Practice location
1995 E 17th St Ste AIdaho Falls, ID 83404-6493
Phone 208-522-7666 · Fax 208-524-2821
Mailing address
1995 E 17th St Ste AIdaho Falls, ID 83404-6493
Phone 208-522-7666 · Fax 208-524-2821
Authorized official
Shane G Machen
Owner
2085227666
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