| Southwest District Health | |
|
13307 Miami Ln Caldwell ID 83607-4701 | |
| (208) 455-5305 | |
| (208) 455-5368 |
| Full Name | Southwest District Health |
|---|---|
| Speciality | Public Health or Welfare |
| Location | 13307 Miami Ln, Caldwell, Idaho |
| Authorized Official Name and Position | Kelly S Boster (OFFICE SPECIALIST II) |
| Authorized Official Contact | 2084555348 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest District Health 13307 Miami Ln Caldwell ID 83607-4701 Ph: (208) 455-5305 | Southwest District Health 13307 Miami Ln Caldwell ID 83607-4701 Ph: (208) 455-5305 |
| NPI Number | 1598748337 |
|---|---|
| Provider Enumeration Date | 11/25/2005 |
| Last Update Date | 02/02/2024 |
| Certification Date | 02/02/2024 |
| Medicare PECOS PAC ID | 0143465666 |
|---|---|
| Medicare Enrollment ID | O20130403000376 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598748337 | NPI | - | NPPES |
| 002824100 | Medicaid | HI | |
| 002828400 | Medicaid | ID | |
| 002821600 | Medicaid | ID | |
| 805201700 | Medicaid | ID |
| Provider Name | San Juanita Aguilar |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1881930378 PECOS PAC ID: 7618955543 Enrollment ID: I20040708000740 |
| Provider Name | James C Roscoe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871522086 PECOS PAC ID: 5395838270 Enrollment ID: I20070908000128 |
| Provider Name | Charles H Washington |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497998538 PECOS PAC ID: 2769638923 Enrollment ID: I20130923000483 |
| Provider Name | Jami B Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225161839 PECOS PAC ID: 7719085166 Enrollment ID: I20210303001499 |
| Provider Name | Chrysanthe Kepas Eastman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427650266 PECOS PAC ID: 8628484920 Enrollment ID: I20210322002696 |
| Provider Name | Molly Prengaman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255531976 PECOS PAC ID: 2365833787 Enrollment ID: I20211220000759 |
| Provider Name | Paola F Beach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336861194 PECOS PAC ID: 6305216060 Enrollment ID: I20221221002795 |
| Provider Name | Alivia Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780383166 PECOS PAC ID: 3971968165 Enrollment ID: I20230421001293 |
| Provider Name | Perry A. Jansen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417230251 PECOS PAC ID: 0345408647 Enrollment ID: I20230621002142 |
| Provider Name | Cynthia Floyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033871819 PECOS PAC ID: 8224425368 Enrollment ID: I20240216004399 |
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