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201 N 8th St Ste 4 Saint Maries ID 83861-1869 | |
(208) 597-7639 | |
(208) 717-9450 |
Full Name | |
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Speciality | Clinic/Center |
Location | 201 N 8th St Ste 4, Saint Maries, Idaho |
Authorized Official Name and Position | Alyssa Robinson (MEMBER) |
Authorized Official Contact | 2085824202 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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201 N 8th St Ste 4 Saint Maries ID 83861-1869 Ph: (208) 597-7639 | 201 N 8th St Ste 4 Saint Maries ID 83861-1869 Ph: (208) 597-7639 |
NPI Number | 1053997197 |
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Provider Enumeration Date | 03/19/2021 |
Last Update Date | 05/11/2021 |
Certification Date | 05/11/2021 |
Medicare PECOS PAC ID | 6002210713 |
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Medicare Enrollment ID | O20210803001179 |
Identifier | Type | State | Issuer |
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1053997197 | NPI | - | NPPES |
Provider Name | Laura Elaine Cartwright |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1457664294 PECOS PAC ID: 7113173451 Enrollment ID: I20120802000070 |
Provider Name | Marissa Kay Carlson |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1124631171 PECOS PAC ID: 8022412733 Enrollment ID: I20230703002720 |