| Innovative Health Care Concepts, Inc | |
|
111 E 16th St Idaho Falls Idaho Falls ID 83404-5919 | |
| (208) 523-1130 | |
| (208) 529-6501 |
| Full Name | Innovative Health Care Concepts, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 111 E 16th St, Idaho Falls, Idaho |
| Authorized Official Name and Position | Lisa Michelle Smith (PROGRAM DIRECTOR) |
| Authorized Official Contact | 2085231130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Health Care Concepts, Inc 790 S Holmes Ave Idaho Falls ID 83401-4749 Ph: (208) 529-8526 | Innovative Health Care Concepts, Inc 111 E 16th St Idaho Falls Idaho Falls ID 83404-5919 Ph: (208) 523-1130 |
| NPI Number | 1427108323 |
|---|---|
| Provider Enumeration Date | 01/11/2007 |
| Last Update Date | 01/23/2023 |
| Certification Date | 01/23/2023 |
| Medicare PECOS PAC ID | 8628391117 |
|---|---|
| Medicare Enrollment ID | O20150109000295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427108323 | NPI | - | NPPES |
| 002741600 | Medicaid | ID |
| Provider Name | Jillian Mitki |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710231436 PECOS PAC ID: 8527211754 Enrollment ID: I20170321002410 |
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