Provider Demographics
NPI:1952324188
Name:COMMUNITY CARE PLLC
Entity Type:Organization
Organization Name:COMMUNITY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-525-8448
Mailing Address - Street 1:167 E 1ST S
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-1401
Mailing Address - Country:US
Mailing Address - Phone:208-745-8747
Mailing Address - Fax:208-745-9396
Practice Address - Street 1:167 E 1ST S
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-1401
Practice Address - Country:US
Practice Address - Phone:208-745-8747
Practice Address - Fax:208-745-9396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty