Provider Demographics
NPI:1740544089
Name:FIRTH MEDICAL CENTER PLLC
Entity type:Organization
Organization Name:FIRTH MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEARLE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:208-221-5931
Mailing Address - Street 1:114 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FIRTH
Mailing Address - State:ID
Mailing Address - Zip Code:83236-1168
Mailing Address - Country:US
Mailing Address - Phone:208-346-6614
Mailing Address - Fax:208-346-6638
Practice Address - Street 1:114 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FIRTH
Practice Address - State:ID
Practice Address - Zip Code:83236-1168
Practice Address - Country:US
Practice Address - Phone:208-346-6614
Practice Address - Fax:208-346-6638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-657A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty