Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 4002 E 397 N, Rigby, Idaho |
Authorized Official Name and Position | Marlen Villegas (MEDICAL BILLING SPECIALIST) |
Authorized Official Contact | 2085287655 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
2100 Alan St Idaho Falls ID 83404 Ph: (208) 528-7655 | 4002 E 397 N Rigby ID 83442 Ph: (208) 528-7655 |
NPI Number | 1710664834 |
---|---|
Provider Enumeration Date | 06/30/2023 |
Last Update Date | 11/13/2023 |
Medicare PECOS PAC ID | 6204877467 |
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Medicare Enrollment ID | O20240705000969 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710664834 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Upper Valley Family Medicine Rhc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 530 Rigby Lake Dr, Rigby, ID 83442 Phone: 208-745-5021 Fax: 208-745-5026 | |
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