PRIMARY CARE SPECIALISTS PA NPI 1508875881

NPI Information

PRIMARY CARE SPECIALISTS, PA is a primary care clinic center in Pocatello, ID. PRIMARY CARE SPECIALISTS, PA NPI is 1508875881. The provider is registered as an organization entity type.

The provider's business location address is:

110 VISTA DRIVE
POCATELLO, ID
ZIP 83201
Phone: (208) 234-2300
Fax: (208) 234-0026

The provider's authorized official is Mark L Mansfield .
The authorized official title is President and has the following contact phone number (208) 234-2300.

The CLIA number assigned to this NPI record is 13D0935096 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 8/5/2006 and was last updated on 9/18/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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