Provider Demographics
NPI:1043099310
Name:VIRTARE HEALTH PHYSICIAN SERVICES OF IDAHO PLLC
Entity type:Organization
Organization Name:VIRTARE HEALTH PHYSICIAN SERVICES OF IDAHO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS
Authorized Official - Phone:855-745-8400
Mailing Address - Street 1:10890 THORNMINT RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-2402
Mailing Address - Country:US
Mailing Address - Phone:855-745-8400
Mailing Address - Fax:
Practice Address - Street 1:3597 E MONARCH SKY LN STE 240
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1055
Practice Address - Country:US
Practice Address - Phone:855-745-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty