| Blackfoot Medical Center | |
|
1441 Parkway Dr Blackfoot ID 83221-1667 | |
| (208) 785-2600 | |
| Not Available |
| Full Name | Blackfoot Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 1441 Parkway Dr, Blackfoot, Idaho |
| Authorized Official Name and Position | Ned Hillyard (CHIEF COMPLIANCE OFFICER) |
| Authorized Official Contact | 2085572711 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blackfoot Medical Center 1441 Parkway Dr Blackfoot ID 83221-1667 Ph: (208) 785-2600 | Blackfoot Medical Center 1441 Parkway Dr Blackfoot ID 83221-1667 Ph: (208) 785-2600 |
| NPI Number | 1649699174 |
|---|---|
| Provider Enumeration Date | 04/14/2014 |
| Last Update Date | 04/21/2016 |
| Medicare PECOS PAC ID | 2961791991 |
|---|---|
| Medicare Enrollment ID | O20160608002399 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649699174 | NPI | - | NPPES |
| Provider Name | Steven Clinger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790722841 PECOS PAC ID: 1557270493 Enrollment ID: I20031113000103 |
| Provider Name | Francis Moser |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770541146 PECOS PAC ID: 5991619827 Enrollment ID: I20031115000025 |
| Provider Name | Douglas U Blank |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1871598631 PECOS PAC ID: 5799680443 Enrollment ID: I20031204001092 |
| Provider Name | John D Chambers |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1578568242 PECOS PAC ID: 3476458134 Enrollment ID: I20031204001113 |
| Provider Name | Patrick D Gorman |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1295735769 PECOS PAC ID: 1254320054 Enrollment ID: I20040507000624 |
| Provider Name | Gary Soucie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255386082 PECOS PAC ID: 4183614076 Enrollment ID: I20040513000679 |
| Provider Name | Gordon E Dixon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578518395 PECOS PAC ID: 3274442116 Enrollment ID: I20040929000890 |
| Provider Name | Guss R Grimmett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881620730 PECOS PAC ID: 7214906577 Enrollment ID: I20041002000031 |
| Provider Name | David R Donaldson |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1114914512 PECOS PAC ID: 4587681515 Enrollment ID: I20051028000946 |
| Provider Name | Francis T Johansen |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1447253968 PECOS PAC ID: 7810974433 Enrollment ID: I20060821000457 |
| Provider Name | David J Chamberlain |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1366465197 PECOS PAC ID: 4981609062 Enrollment ID: I20060923000005 |
| Provider Name | Paul Beckett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831115757 PECOS PAC ID: 8729057161 Enrollment ID: I20061013000590 |
| Provider Name | Matthew Fackrell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215968045 PECOS PAC ID: 2668400458 Enrollment ID: I20070924000249 |
| Provider Name | Hyrum Davenport |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255567210 PECOS PAC ID: 4789736083 Enrollment ID: I20090717000227 |
| Provider Name | Joy H Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184850141 PECOS PAC ID: 6800949264 Enrollment ID: I20090803000024 |
| Provider Name | Paul A Gerlach |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1215025648 PECOS PAC ID: 2668626284 Enrollment ID: I20130207000380 |
| Provider Name | Susan B Wachter |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1740450014 PECOS PAC ID: 6901935873 Enrollment ID: I20130603000168 |
| Provider Name | Max Barney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720448590 PECOS PAC ID: 8022317940 Enrollment ID: I20160427002159 |
| Provider Name | Kenneth Lightheart |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1740290360 PECOS PAC ID: 2365543600 Enrollment ID: I20160520000676 |
| Provider Name | Travis Erickson |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1952350431 PECOS PAC ID: 5496992893 Enrollment ID: I20180426002700 |
| Provider Name | Brodi Smith |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1447690904 PECOS PAC ID: 0143463612 Enrollment ID: I20180809004459 |
| Provider Name | Jared K. Manwaring |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235573148 PECOS PAC ID: 1456600386 Enrollment ID: I20180824002609 |
| Provider Name | Dellisa Dawn Eddington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356812945 PECOS PAC ID: 2264773902 Enrollment ID: I20190408001311 |
| Provider Name | Jason Knighton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285199869 PECOS PAC ID: 3274967708 Enrollment ID: I20191216002801 |
| Provider Name | Shayna Larae Harding |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043880669 PECOS PAC ID: 7113322926 Enrollment ID: I20210817002505 |
| Provider Name | Scott Hall |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1811343692 PECOS PAC ID: 7416241922 Enrollment ID: I20210826002652 |
| Provider Name | Ryan Mcbride |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083297220 PECOS PAC ID: 8527464817 Enrollment ID: I20210913001381 |
| Provider Name | Carden Gambee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619218567 PECOS PAC ID: 6406173608 Enrollment ID: I20220630002158 |
| Provider Name | Brett Mcbride |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1770017568 PECOS PAC ID: 9335529700 Enrollment ID: I20220630002783 |
| Provider Name | Danielle E Bangerter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164204368 PECOS PAC ID: 3072952308 Enrollment ID: I20240418002552 |
Idaho Physicians Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 98 Poplar St, Blackfoot, ID 83221 Phone: 208-785-3800 | |
Blackfoot Medical Clinic Rhc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1441 Parkway Dr, Blackfoot, ID 83221 Phone: 208-785-2600 | |
Blackfoot Medical Clinic, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1441 Parkway Dr, Blackfoot, ID 83221 Phone: 208-785-2600 Fax: 208-785-8185 | |
Intercept Systems, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 140 N 700 W, Blackfoot, ID 83221 Phone: 208-201-0795 | |
Peak Family Medicine, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1495 Parkway Dr Ste C, Blackfoot, ID 83221 Phone: 208-643-4231 Fax: 208-643-4235 | |
Cedar Creek Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 98 Poplar St, Blackfoot, ID 83221 Phone: 208-782-3700 | |
Community Family Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1491 Parkway Dr, Blackfoot, ID 83221 Phone: 208-782-0500 Fax: 844-328-7224 |