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FAMILY CARE CLINIC

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Company Details

Name: FAMILY CARE CLINIC
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 08 Jul 2010 (15 years ago)
Entity Number: 428636
Place of Formation: IDAHO
File Number: 0000428636
ZIP code: 83704
County: Ada County
Mailing Address: 8050 W RIFLEMAN #100 BOISE, ID 83704

National Provider Identifier

NPI Number:
1770817413

Authorized Person:

Name:
LAURIE MILLER
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2083211082

Filing

Filing Name Filing Number Filing date
Initial Filing 0000428636 2010-07-08

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Date of last update: 25 Sep 2024

Sources: Idaho Secretary of State