| Fifth Avenue Clinic | |
|
115 5th Ave W Jerome ID 83338-1824 | |
| (208) 324-8831 | |
| (208) 324-6678 |
| Full Name | Fifth Avenue Clinic |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 115 5th Ave W, Jerome, Idaho |
| Authorized Official Name and Position | Warren Alan Stevenson (CEO) |
| Authorized Official Contact | 2083241122 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fifth Avenue Clinic 115 5th Ave W Jerome ID 83338-1824 Ph: (208) 324-8831 | Fifth Avenue Clinic 115 5th Ave W Jerome ID 83338-1824 Ph: (208) 324-8831 |
| NPI Number | 1922037530 |
|---|---|
| Provider Enumeration Date | 07/03/2006 |
| Last Update Date | 05/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922037530 | NPI | - | NPPES |
| 807893400 | Medicaid | ID | |
| 002287100 | Medicaid | ID | |
| 8A489 | Other | ID | BLUE CROSS OF IDAHO |
| 000010006293 | Other | ID | REGENCE BLUE SHIELD OF ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (Idaho) | Primary |
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