Bank Street Clinic | |
516 Bank St Wallace ID 83873-2225 | |
(208) 752-3016 | |
(208) 753-1001 |
Full Name | Bank Street Clinic |
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Speciality | Family Medicine |
Location | 516 Bank St, Wallace, Idaho |
Authorized Official Name and Position | Deborah Lois Elliott-pearson (CEO) |
Authorized Official Contact | 2087523016 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Bank Street Clinic 516 Bank St Wallace ID 83873-2225 Ph: (208) 752-3016 | Bank Street Clinic 516 Bank St Wallace ID 83873-2225 Ph: (208) 752-3016 |
NPI Number | 1619142452 |
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Provider Enumeration Date | 04/23/2008 |
Last Update Date | 04/29/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619142452 | NPI | - | NPPES |
805230000 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | M7469 (Idaho) | Primary |