OrganizationActive
Payette Lakes Medical Clinic, PA
NPI 1902937196 · Primary Care Clinic/Center · Donnelly, ID
Provider details
- NPI number
- 1902937196
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Jacqueline Bruns, Vp - Physician Services(208) 634-4061
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
454 Rosebury Road
Suite 103
Donnelly, ID 83615
Phone: (208) 325-4455
Fax: (208) 325-4466
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 1047
Mccall, ID 83638-1047
Other names (DBA / former)
- Other name
- Donnelly Medical Clinic
Registry dates
- Enumerated
- 2007-03-08
- Last updated
- 2008-03-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.