| Falls Centre For Functional Medicine, Pllc. | |
|
236 Martin St Twin Falls ID 83301-4542 | |
| (208) 733-4444 | |
| (208) 733-4456 |
| Full Name | Falls Centre For Functional Medicine, Pllc. |
|---|---|
| Speciality | Family Medicine |
| Location | 236 Martin St, Twin Falls, Idaho |
| Authorized Official Name and Position | Geoffrey Neil Hicks (PROVIDER) |
| Authorized Official Contact | 2087334444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Falls Centre For Functional Medicine, Pllc. 236 Martin St Twin Falls ID 83301-4542 Ph: (208) 733-4444 | Falls Centre For Functional Medicine, Pllc. 236 Martin St Twin Falls ID 83301-4542 Ph: (208) 733-4444 |
| NPI Number | 1962916304 |
|---|---|
| Provider Enumeration Date | 11/21/2017 |
| Last Update Date | 02/14/2018 |
| Medicare PECOS PAC ID | 4880954197 |
|---|---|
| Medicare Enrollment ID | O20180206002328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962916304 | NPI | - | NPPES |
| 807183500 | Medicaid | ID | |
| 1730283250 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | O-180 (Idaho) | Primary |
| 208VP0000X | Pain Medicine - Pain Medicine | O-180 (Idaho) | Secondary |
| Provider Name | Laurence V Hicks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730283250 PECOS PAC ID: 7719922475 Enrollment ID: I20050622001372 |
| Provider Name | Geoffrey N Hicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467966671 PECOS PAC ID: 4183987852 Enrollment ID: I20180410002235 |
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