Organization · NPI-2

Ideal Family Medicine

Clinic/Center · Palmer, AK

NPI number1316489354
StatusActive
Last updated in NPPESDec 19, 2016

Details

NPI
1316489354
Entity type
Organization (NPI-2)
Legal business name
Ideal Family Medicine
Organization subpart
No
Enumeration date
Nov 8, 2016
Last updated
Dec 19, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes

Practice location

440 W Evergreen Ave
Suite A
Palmer, AK 99645-6984

Phone 907-746-3366

Mailing address

440 W Evergreen Ave
Suite A
Palmer, AK 99645-6984

Phone 907-746-3366

Authorized official

Babee Angelynne Mitchell
Physician Assistant
9077463366

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