Provider Demographics
NPI:1750998126
Name:STORY FAMILY MEDICINE
Entity type:Organization
Organization Name:STORY FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:STORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-310-7773
Mailing Address - Street 1:1150 ALTURAS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3263
Mailing Address - Country:US
Mailing Address - Phone:208-310-7773
Mailing Address - Fax:208-301-6030
Practice Address - Street 1:1150 ALTURAS DR STE 101
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3263
Practice Address - Country:US
Practice Address - Phone:208-310-7773
Practice Address - Fax:208-301-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty