| Idahodhwbh3 Payette Amh Psr | |
|
515 16th Ave N Payette ID 83661-2047 | |
| (208) 642-6416 | |
| (208) 642-2829 |
| Full Name | Idahodhwbh3 Payette Amh Psr |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 515 16th Ave N, Payette, Idaho |
| Authorized Official Name and Position | Todd L Hurt (FIELD OPERATIONS MANAGER) |
| Authorized Official Contact | 2084557057 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idahodhwbh3 Payette Amh Psr 515 16th Ave N Payette ID 83661-2047 Ph: (208) 642-6416 | Idahodhwbh3 Payette Amh Psr 515 16th Ave N Payette ID 83661-2047 Ph: (208) 642-6416 |
| NPI Number | 1568590073 |
|---|---|
| Provider Enumeration Date | 02/28/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568590073 | NPI | - | NPPES |
| 000010027633 | Other | ID | BLUESHIELD |
| 8073591 | Medicaid | ID | |
| HW298 | Other | ID | BLUE CROSS OF IDAHO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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Idahodhwbh Payettamhclinic Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 515 16th Ave N, Payette, ID 83661 Phone: 208-642-6416 Fax: 208-642-2829 |