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RIVER MEDICAL FAMILY MEDICINE, PLLC

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Company Details

Name: RIVER MEDICAL FAMILY MEDICINE, PLLC
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 16 Mar 2011 (14 years ago)
Entity Number: 444783
Place of Formation: IDAHO
File Number: 0000444783
ZIP code: 83616
County: Ada County
Mailing Address: 100 W COTTONWOOD STE 150 EAGLE, ID 83616

National Provider Identifier

NPI Number:
1194835546

Authorized Person:

Name:
MICHAEL R. MINAS
Role:
PHYSICIAN
Phone:

Taxonomy:

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

Contacts:

Fax:
2089393315

Filing

Filing Name Filing Number Filing date
Initial Filing 0000444783 2011-03-16

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State