Provider Demographics
NPI:1629139720
Name:CARING PHYSICIAN'S MEDICAL CLINIC
Entity Type:Organization
Organization Name:CARING PHYSICIAN'S MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-762-5577
Mailing Address - Street 1:8827 N GOVERNMENT WAY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8231
Mailing Address - Country:US
Mailing Address - Phone:208-762-5577
Mailing Address - Fax:208-762-5520
Practice Address - Street 1:8827 N GOVERNMENT WAY UNIT 2
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8231
Practice Address - Country:US
Practice Address - Phone:208-762-5577
Practice Address - Fax:208-762-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010151310OtherREGENCE
ID003594300Medicaid
IDPIN B5688 GR 8M925OtherBLUE CROSS
IDPIN B5688 GR 8M925OtherBLUE CROSS
ID000010151310OtherREGENCE
ID003594300Medicaid
ID1127969Medicare PIN