| |
1252 Bennett Ave Suite B Burley ID 83318 | |
(208) 617-0656 | |
(208) 647-0659 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 1252 Bennett Ave, Burley, Idaho |
Authorized Official Name and Position | Jeremy B Haymore (MEDICAL DIRECTOR) |
Authorized Official Contact | 2083122242 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
260 Falls Ave Ste C Twin Falls ID 83301-3370 Ph: (208) 736-7422 | 1252 Bennett Ave Suite B Burley ID 83318 Ph: (208) 617-0656 |
NPI Number | 1487151882 |
---|---|
Provider Enumeration Date | 04/11/2018 |
Last Update Date | 02/01/2019 |
Medicare PECOS PAC ID | 1557614369 |
---|---|
Medicare Enrollment ID | O20190306000972 |
Identifier | Type | State | Issuer |
---|---|---|---|
1487151882 | NPI | - | NPPES |
1487151882 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | M-4391 (Idaho) | Primary |
Provider Name | Jeremy Haymore |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1265547582 PECOS PAC ID: 6709989387 Enrollment ID: I20081028000788 |
Wayne H Blauer Md Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1501 Hiland Ave, Ste L3, Burley, ID 83318 Phone: 208-678-2283 Fax: 208-677-2483 | |
Albion Valley Health Clinic Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 West 5th Street, Burley, ID 83318 Phone: 208-312-9740 Fax: 208-678-0910 | |