Amanda Lee, | |
1620 S Kimball Ave, Caldwell, ID 83605-4547 | |
(208) 505-2950 | |
Not Available |
Full Name | Amanda Lee |
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Gender | Female |
Speciality | Pediatrics |
Location | 1620 S Kimball Ave, Caldwell, Idaho |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1154647261 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | A-1749-13 (New Mexico) | Secondary |
208000000X | Pediatrics | OP60471366 (Washington) | Secondary |
208000000X | Pediatrics | 0-1639 (Idaho) | Primary |
Entity Name | St Lukes Clinic-treasure Valley Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1326336058 PECOS PAC ID: 4981878402 Enrollment ID: O20111119000045 |
Mailing Address | Practice Location Address |
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Amanda Lee, 190 E Bannock St, Boise, ID 83712-6241 Ph: () - | Amanda Lee, 1620 S Kimball Ave, Caldwell, ID 83605-4547 Ph: (208) 505-2950 |
Jee Hur, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 315 E Elm Street, Ste 100, Caldwell, ID 83605 Phone: 208-459-7415 Fax: 208-453-3307 | |
Natasha Miller, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 315 E Elm, Ste 100, Caldwell, ID 83605 Phone: 208-459-7415 Fax: 208-453-3307 | |
Merle L. Keller Iii, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 315 E. Elm Ste 100, Caldwell, ID 83605 Phone: 208-302-7100 Fax: 208-302-7155 | |
Matthew S Brown, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 315 E Elm St Ste 100, Caldwell, ID 83605 Phone: 208-302-7100 Fax: 208-302-7189 | |
Timothy Curtis Borup, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 315 E Elm St Ste 100, Caldwell, ID 83605 Phone: 208-302-7100 Fax: 208-302-7155 | |
David Babbel, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 315 E Elm St, Caldwell, ID 83605 Phone: 208-302-7100 Fax: 208-302-7155 |