Provider Demographics
NPI:1346441912
Name:WOOD RIVER FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:WOOD RIVER FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARBEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-788-3434
Mailing Address - Street 1:706 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8400
Mailing Address - Country:US
Mailing Address - Phone:208-788-3434
Mailing Address - Fax:208-788-2025
Practice Address - Street 1:706 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8400
Practice Address - Country:US
Practice Address - Phone:208-788-3434
Practice Address - Fax:208-788-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty