Provider Demographics
NPI:1881659357
Name:ASSOCIATES IN FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:ASSOCIATES IN FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLIESLAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-934-5900
Mailing Address - Street 1:640 FROGS LANDING
Mailing Address - Street 2:
Mailing Address - City:HAGERMAN
Mailing Address - State:ID
Mailing Address - Zip Code:83332
Mailing Address - Country:US
Mailing Address - Phone:208-837-6161
Mailing Address - Fax:208-837-9193
Practice Address - Street 1:425 IDAHO ST
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330
Practice Address - Country:US
Practice Address - Phone:208-934-5900
Practice Address - Fax:208-934-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
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
133845Medicare Oscar/Certification
1375365Medicare ID - Type UnspecifiedPART B