Provider Demographics
NPI:1912723214
Name:FAMILY PRACTICE GROUP, P.A.
Entity type:Organization
Organization Name:FAMILY PRACTICE GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED CODER
Authorized Official - Prefix:
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROPICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-238-1000
Mailing Address - Street 1:1951 BENCH RD STE B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2073
Mailing Address - Country:US
Mailing Address - Phone:208-238-1000
Mailing Address - Fax:208-238-0009
Practice Address - Street 1:1951 BENCH RD STE B
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2073
Practice Address - Country:US
Practice Address - Phone:208-238-1000
Practice Address - Fax:208-238-0009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY PRACTICE GROUP, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities