Archie, Thomas E

Archie, Thomas E is an individual health care provider with primary practice located at 1450 Aviation Dr Suite 100, Hailey ID 83333-8785. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Other Service Providers / Acupuncturist. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Archie, Thomas E can be contacted via phone (208) 788-3434.

Contact Information

Primary practice address
1450 Aviation Dr Suite 100 Hailey ID 83333-8785
Phone: (208) 788-3434
Fax: (208) 788-2025
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X M10114 Idaho
Other Service Providers / Acupuncturist 171100000X M10114 Idaho

Profile Details

NPI number 1023073897
LBN Legal business name Archie, Thomas E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 17th, 2006
Last updated Jul 24th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023073897 NPPES
Idaho Other P00697901 MCRR
Idaho MEDICAID 807891600 MCRR

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