Bore Llc | |
1498 Midway Ave Ste 2 Ammon ID 83406-4587 | |
(208) 529-9930 | |
Not Available |
Full Name | Bore Llc |
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Speciality | Family Medicine |
Location | 1498 Midway Ave Ste 2, Ammon, Idaho |
Authorized Official Name and Position | Heather Fumich (CONTRACTING) |
Authorized Official Contact | 5035020655 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Bore Llc 1498 Midway Ave Ste 2 Ammon ID 83406-4587 Ph: () - | Bore Llc 1498 Midway Ave Ste 2 Ammon ID 83406-4587 Ph: (208) 529-9930 |
NPI Number | 1447880570 |
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Provider Enumeration Date | 01/16/2020 |
Last Update Date | 01/16/2020 |
Medicare PECOS PAC ID | 9133556590 |
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Medicare Enrollment ID | O20200224002432 |
Identifier | Type | State | Issuer |
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1447880570 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Brian D Jones |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1922413699 PECOS PAC ID: 9234432675 Enrollment ID: I20180123003465 |
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