Provider Demographics
NPI:1770059792
Name:NEW PLYMOUTH CLINIC
Entity type:Organization
Organization Name:NEW PLYMOUTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:STERNES
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:208-631-5375
Mailing Address - Street 1:8611 DEWEY RD
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-8855
Mailing Address - Country:US
Mailing Address - Phone:208-631-5375
Mailing Address - Fax:
Practice Address - Street 1:213 N PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:NEW PLYMOUTH
Practice Address - State:ID
Practice Address - Zip Code:83655-5532
Practice Address - Country:US
Practice Address - Phone:208-631-5375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service