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2273 S. Vista Ave 190 Boise ID 83705 | |
| (208) 343-2737 | |
| (208) 343-3238 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 2273 S. Vista Ave, Boise, Idaho |
| Authorized Official Name and Position | Cheryl Green (BILLING SUPERVISOR) |
| Authorized Official Contact | 2085054419 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1811 E. Karcher Road Nampa ID 83687 Ph: (208) 505-4419 | 2273 S. Vista Ave 190 Boise ID 83705 Ph: (208) 343-2737 |
| NPI Number | 1871259770 |
|---|---|
| Provider Enumeration Date | 11/15/2021 |
| Last Update Date | 02/04/2025 |
| Certification Date | 02/04/2025 |
| Medicare PECOS PAC ID | 8729472238 |
|---|---|
| Medicare Enrollment ID | O20220228000470 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871259770 | NPI | - | NPPES |
| Provider Name | Aida Dizdar-barac |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952655490 PECOS PAC ID: 2365743325 Enrollment ID: I20151216000308 |
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