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MOUNTAIN STATE FAMILY MEDICINE, PC
NPI 1710917612
Clinic/Center - Primary Care in Grangeville, ID

Active since July 04, 2006
610 NW 2ND ST, GRANGEVILLE, ID 83530(208) 983-5120(208) 983-5404 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mountain State Family Medicine, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOUNTAIN STATE FAMILY MEDICINE, PC (NPI 1710917612) is a healthcare organization registered as a primary care in Grangeville, Idaho and active in the NPI registry since July 2006. The organization lists Leanne L Leblanc, President, as its authorized official.

NPPES Registry Identity

NPI1710917612
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameMOUNTAIN STATE FAMILY MEDICINE, PC
Location Address610 NW 2ND STGrangeville, ID 83530-1244
Mailing Address610 Nw 2nd StGrangeville, ID 83530-1244 · (208) 983-5120 · Fax (208) 983-5404
Phone(208) 983-5120
Fax(208) 983-5404
Organization SubpartNo
Authorized OfficialLeanne L LeblancPresident · (208) 983-5120
Enumeration DateJuly 4, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1710917612 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
610 NW 2ND ST, Grangeville, ID 83530
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Other Identifiers 2

Other000010017999ID · Regence Blue Shield
Other8M434ID · Blue Cross Of Idaho

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WILLIAM MARK IMUS JR. FNP
Nurse Practitioner
610 NW 2ND ST
GRANGEVILLE, ID 83530
Idaho County (208) 983-5120

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mountain State Family Medicine, PC's NPI number?

The NPI number for Mountain State Family Medicine, PC is 1710917612. It was assigned to this organization in the NPPES registry on July 4, 2006.

Where is Mountain State Family Medicine, PC located?

Mountain State Family Medicine, PC is located at 610 NW 2nd St, Grangeville, ID 83530. The listed phone number is (208) 983-5120.

What is Mountain State Family Medicine, PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

When was this NPI record last updated?

The NPPES record for Mountain State Family Medicine, PC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.