Provider Demographics
NPI:1235306861
Name:MCCALL MEDICAL CLINICS
Entity Type:Organization
Organization Name:MCCALL MEDICAL CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GROENIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-634-4061
Mailing Address - Street 1:1000 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-3704
Mailing Address - Country:US
Mailing Address - Phone:208-634-4061
Mailing Address - Fax:208-634-7112
Practice Address - Street 1:209 FOREST ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-5256
Practice Address - Country:US
Practice Address - Phone:208-634-1776
Practice Address - Fax:208-634-3873
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCALL MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-13
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital