Provider Demographics
NPI:1144412719
Name:KUNA MINOR EMERGENCY LLC
Entity Type:Organization
Organization Name:KUNA MINOR EMERGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:208-922-5338
Mailing Address - Street 1:708 E WYTHE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-2473
Mailing Address - Country:US
Mailing Address - Phone:208-922-5338
Mailing Address - Fax:208-922-5340
Practice Address - Street 1:708 E WYTHE CREEK CT
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-2473
Practice Address - Country:US
Practice Address - Phone:208-922-5338
Practice Address - Fax:208-922-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty