Provider Demographics
NPI:1336526771
Name:QUIK-MED HEALTH CLINIC PLLC
Entity Type:Organization
Organization Name:QUIK-MED HEALTH CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MSM,FNP-C
Authorized Official - Phone:208-946-5100
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:CLARK FORK
Mailing Address - State:ID
Mailing Address - Zip Code:83811-0567
Mailing Address - Country:US
Mailing Address - Phone:208-946-5100
Mailing Address - Fax:
Practice Address - Street 1:104 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:CLARK FORK
Practice Address - State:ID
Practice Address - Zip Code:83811
Practice Address - Country:US
Practice Address - Phone:208-946-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center