Dr Eliza S Petersen, AUD, CCCA is a medicare enrolled "Audiologist" provider in Driggs, Idaho. Her current practice location is
2740 Shadowmoon Ln Ste 417, Driggs, Idaho. You can reach out to her office (for appointments etc.) via phone at
(307) 745-5587.
Dr Eliza S Petersen is licensed to practice in Idaho (license number AUD-1142) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1083750996.
Healthcare Provider's Profile
| Full Name | Dr Eliza S Petersen |
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| Gender | Female |
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| Speciality | Audiologist |
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| Location | 2740 Shadowmoon Ln Ste 417, Driggs, Idaho |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1083750996
- Provider Enumeration Date: 01/29/2007
- Last Update Date: 04/19/2023
Medicare PECOS Information:
- PECOS PAC ID: 0749342152
- Enrollment ID: I20090723000159
Medical Identifiers
Medical identifiers for Dr Eliza S Petersen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1083750996 | NPI | - | NPPES |
| 807694600 | Medicaid | ID | |
| 125563100 | Medicaid | WY | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 231H00000X | Audiologist | A-974 (Wyoming) | Secondary |
| 231H00000X | Audiologist | AUD-1142 (Idaho) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Eliza S Petersen is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Eliza S Petersen, AUD, CCCA
1388 Mount Moriah Rd,
Livermore, CO 80536-9311
Ph: (307) 745-5587 | Dr Eliza S Petersen, AUD, CCCA
2740 Shadowmoon Ln Ste 417,
Driggs, ID 83422-5083
Ph: (307) 745-5587 |
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