Provider Demographics
NPI:1679737217
Name:UPPER VALLEY FAMILY MEDICINE PA
Entity type:Organization
Organization Name:UPPER VALLEY FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SAFARIK
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:208-745-6717
Mailing Address - Street 1:530 RIGBY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-1271
Mailing Address - Country:US
Mailing Address - Phone:208-745-5021
Mailing Address - Fax:208-745-5026
Practice Address - Street 1:530 RIGBY LAKE DR
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-1271
Practice Address - Country:US
Practice Address - Phone:208-745-5021
Practice Address - Fax:208-745-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty