Provider Demographics
NPI:1093056475
Name:FRANKLIN COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:FRANKLIN COUNTY MEDICAL CENTER
Other - Org Name:WILLOW VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOYES
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:208-852-2900
Mailing Address - Street 1:47 N 1ST E
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-1325
Mailing Address - Country:US
Mailing Address - Phone:208-852-2900
Mailing Address - Fax:208-852-3511
Practice Address - Street 1:47 N 1ST E
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263-1325
Practice Address - Country:US
Practice Address - Phone:208-852-2900
Practice Address - Fax:208-852-3511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANKLIN COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty