Full Name | |
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Speciality | Clinic/Center |
Location | 205 E Main St, Declo, Idaho |
Authorized Official Name and Position | Aaron James Houston (CEO) |
Authorized Official Contact | 2087376708 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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794 Eastland Dr Twin Falls ID 83301-6856 Ph: (208) 734-3312 | 205 E Main St Declo ID 83323-5085 Ph: (208) 678-0101 |
NPI Number | 1285297804 |
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Provider Enumeration Date | 04/18/2019 |
Last Update Date | 03/17/2021 |
Certification Date | 03/17/2021 |
Medicare PECOS PAC ID | 7012815038 |
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Medicare Enrollment ID | O20230105002714 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285297804 | NPI | - | NPPES |