Organization · NPI-2

Clinic At Eagle LLC

Family Medicine · Eagle, ID

NPI number1306807441
StatusActive
Last updated in NPPESJul 27, 2010

Details

NPI
1306807441
Entity type
Organization (NPI-2)
Legal business name
Clinic At Eagle LLC
Organization subpart
No
Enumeration date
Mar 29, 2006
Last updated
Jul 27, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes

Practice location

600 E State St
Suite 200
Eagle, ID 83616-6081

Phone 208-939-2237 · Fax 208-939-5888

Mailing address

Po Box 9589
Boise, ID 83707-4589

Phone 208-472-8112 · Fax 208-472-8172

Authorized official

Kathe Alkire
Owner
2089392273

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