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1846 1st St # 1011 Idaho Falls ID 83401-4415 | |
| (208) 254-1882 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1846 1st St # 1011, Idaho Falls, Idaho |
| Authorized Official Name and Position | Jonathan Riley Murdock (OWNER/THERAPIST) |
| Authorized Official Contact | 2082541882 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1846 1st St # 1011 Idaho Falls ID 83401-4415 Ph: (208) 254-1882 | 1846 1st St # 1011 Idaho Falls ID 83401-4415 Ph: (208) 254-1882 |
| NPI Number | 1578325247 |
|---|---|
| Provider Enumeration Date | 01/26/2024 |
| Last Update Date | 10/07/2024 |
| Certification Date | 10/07/2024 |
| Medicare PECOS PAC ID | 1557809845 |
|---|---|
| Medicare Enrollment ID | O20240819000133 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578325247 | NPI | - | NPPES |
| Provider Name | Jonathan R Murdock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912205295 PECOS PAC ID: 6305280280 Enrollment ID: I20240219003504 |
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