FALL RIVER MEDICAL, PLLC
Ambulatory Health at Winn Dr, Rexburg, ID

License number
Idaho O-0518
Category
Ambulatory Health
Type
Clinic/Center
License number
Idaho O-0518
Category
Ambulatory Health
Type
Primary Care
License number
Idaho O-0518
Category
Ambulatory Health
Type
Research
License number
Idaho O-0518
Category
Ambulatory Health
Type
Urgent Care
Owner
Name: DR. MARTIN A MANGAN D.O
Title: OWNER
Phone: (208) 220-1057
Address
Address
21 Winn Dr, Rexburg, ID 83440
National Provider ID: 1457698987
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about FALL RIVER MEDICAL, PLLC at bizstanding.com

FALL RIVER MEDICAL, P.L.L.C

21 Winn Dr, Rexburg, ID 83440

Status:
Inactive
Registration:
Apr 13, 2012
Inactive since:
Aug 23, 2013
State ID:
W113011
Business type:
LIMITED LIABILITY COMPANY
Agent:
Martin A Mangan,650 N 4212, Rigby, ID 83442 (Physical)

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