Provider Demographics
NPI:1548200181
Name:FAMILY HEALTH CARE OF POST FALLS, PLLC
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE OF POST FALLS, PLLC
Other - Org Name:NORTHWEST INTEGRATIVE FAMILY MED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:OGLESBAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-773-1311
Mailing Address - Street 1:3773 W 5TH AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6728
Mailing Address - Country:US
Mailing Address - Phone:208-773-1311
Mailing Address - Fax:208-773-1644
Practice Address - Street 1:1110 POLSTON AVE
Practice Address - Street 2:STE 1
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854
Practice Address - Country:US
Practice Address - Phone:208-773-1311
Practice Address - Fax:208-773-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806345800Medicaid
E89865Medicare UPIN