| Community Care, Pllc | |
|
1595 Yellowstone Ave Pocatello ID 83201 | |
| (208) 233-0032 | |
| Not Available |
| Full Name | Community Care, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1595 Yellowstone Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Ryan L Peterson (CEO) |
| Authorized Official Contact | 2085258448 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Care, Pllc 1595 Yellowstone Ave Pocatello ID 83201 Ph: (208) 233-0032 | Community Care, Pllc 1595 Yellowstone Ave Pocatello ID 83201 Ph: (208) 233-0032 |
| NPI Number | 1003088782 |
|---|---|
| Provider Enumeration Date | 04/02/2008 |
| Last Update Date | 08/12/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003088782 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
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