Provider Demographics
NPI:1922029636
Name:FAMILY HEALTH ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:FAMILY HEALTH ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DRURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-765-5922
Mailing Address - Street 1:914 W IRONWOOD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4927
Mailing Address - Country:US
Mailing Address - Phone:208-765-5922
Mailing Address - Fax:
Practice Address - Street 1:914 W IRONWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4927
Practice Address - Country:US
Practice Address - Phone:208-765-5922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002646100Medicaid
ID1372975Medicare ID - Type Unspecified
0328690001Medicare NSC