Provider Demographics
NPI:1295832210
Name:EAGLE'S VIEW FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:EAGLE'S VIEW FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-938-5524
Mailing Address - Street 1:6023 N EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-0997
Mailing Address - Country:US
Mailing Address - Phone:208-938-5524
Mailing Address - Fax:208-938-2510
Practice Address - Street 1:6023 N EAGLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0997
Practice Address - Country:US
Practice Address - Phone:208-938-5524
Practice Address - Fax:208-938-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8C-055OtherBLUE CROSS OF IDAHO