| High Desert Psychiatry Llc | |
|
4477 W Emerald St Ste C275 Boise ID 83706-2078 | |
| (208) 315-6444 | |
| Not Available |
| Full Name | High Desert Psychiatry Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4477 W Emerald St Ste C275, Boise, Idaho |
| Authorized Official Name and Position | Warren Grant Harbison (OWNER) |
| Authorized Official Contact | 2083156444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| High Desert Psychiatry Llc 1775 W State St Ste 123 Boise ID 83702-3924 Ph: (208) 615-6444 | High Desert Psychiatry Llc 4477 W Emerald St Ste C275 Boise ID 83706-2078 Ph: (208) 315-6444 |
| NPI Number | 1851912117 |
|---|---|
| Provider Enumeration Date | 04/28/2020 |
| Last Update Date | 04/28/2020 |
| Certification Date | 04/28/2020 |
| Medicare PECOS PAC ID | 0648693853 |
|---|---|
| Medicare Enrollment ID | O20200707001361 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851912117 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Warren Grant Harbison |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194740019 PECOS PAC ID: 0143255661 Enrollment ID: I20200707001422 |
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