| C/o Physicians Immeidate Care Of Twin | |
|
1252 Bennett Ave Suite B Burley ID 83318 | |
| (208) 617-0656 | |
| (208) 647-0659 |
| Full Name | C/o Physicians Immeidate Care Of Twin |
|---|---|
| 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 |
|---|---|
| C/o Physicians Immeidate Care Of Twin 260 Falls Ave Ste C Twin Falls ID 83301-3370 Ph: (208) 736-7422 | C/o Physicians Immeidate Care Of Twin 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 |
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