Provider Demographics
NPI:1598005233
Name:RIGHT CHOICE URGENT CARE AND FAMILY MEDICINE
Entity Type:Organization
Organization Name:RIGHT CHOICE URGENT CARE AND FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:208-536-9933
Mailing Address - Street 1:280 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:ID
Mailing Address - Zip Code:83355-5201
Mailing Address - Country:US
Mailing Address - Phone:208-536-9933
Mailing Address - Fax:208-536-6214
Practice Address - Street 1:280 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:ID
Practice Address - Zip Code:83355-5201
Practice Address - Country:US
Practice Address - Phone:208-536-9933
Practice Address - Fax:208-536-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-16
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-368363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty