| Northwest Telepsychiatry, Pc | |
|
413 N Allumbaugh St Ste 101 Boise ID 83704-9219 | |
| (208) 323-1125 | |
| Not Available |
| Full Name | Northwest Telepsychiatry, Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 413 N Allumbaugh St Ste 101, Boise, Idaho |
| Authorized Official Name and Position | John Bates (OWNER) |
| Authorized Official Contact | 2083231125 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Telepsychiatry, Pc 413 N Allumbaugh St Ste 101 Boise ID 83704-9219 Ph: (208) 323-1125 | Northwest Telepsychiatry, Pc 413 N Allumbaugh St Ste 101 Boise ID 83704-9219 Ph: (208) 323-1125 |
| NPI Number | 1568025336 |
|---|---|
| Provider Enumeration Date | 04/17/2019 |
| Last Update Date | 05/02/2019 |
| Medicare PECOS PAC ID | 8628304276 |
|---|---|
| Medicare Enrollment ID | O20190719002314 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568025336 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | John Robert Bates |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720170228 PECOS PAC ID: 0941299507 Enrollment ID: I20151130001864 |
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