Provider Demographics
NPI:1124015342
Name:FAMILY CARE PHYSICIANS, PA
Entity Type:Organization
Organization Name:FAMILY CARE PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-324-1157
Mailing Address - Street 1:112 5TH AVE W
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-1825
Mailing Address - Country:US
Mailing Address - Phone:208-324-1157
Mailing Address - Fax:208-324-3604
Practice Address - Street 1:112 5TH AVE W
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-1825
Practice Address - Country:US
Practice Address - Phone:208-324-1157
Practice Address - Fax:208-324-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8064244Medicaid
ID8041512Medicaid
ID8064244Medicaid
ID8041512Medicaid