| Complete Family Care Pllc | |
|
10 Madison Professional Park Rexburg ID 83440-2058 | |
| (208) 656-9467 | |
| (208) 656-9466 |
| Full Name | Complete Family Care Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 10 Madison Professional Park, Rexburg, Idaho |
| Authorized Official Name and Position | Clay Prince (OWNER) |
| Authorized Official Contact | 2086569467 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Complete Family Care Pllc 10 Madison Professional Park Rexburg ID 83440-2058 Ph: (208) 656-9467 | Complete Family Care Pllc 10 Madison Professional Park Rexburg ID 83440-2058 Ph: (208) 656-9467 |
| NPI Number | 1649693649 |
|---|---|
| Provider Enumeration Date | 01/27/2014 |
| Last Update Date | 01/27/2014 |
| Medicare PECOS PAC ID | 9537384557 |
|---|---|
| Medicare Enrollment ID | O20140708001494 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649693649 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M9089 (Idaho) | Primary |
| Provider Name | Clay C Prince |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326152927 PECOS PAC ID: 7012908486 Enrollment ID: I20041026000739 |
| Provider Name | Nichole Jeppesen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275794851 PECOS PAC ID: 3779657952 Enrollment ID: I20080806000365 |
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