| Fremont Medical Center, Pllc | |
|
30 W Main St Saint Anthony ID 83445-2113 | |
| (208) 624-2969 | |
| Not Available |
| Full Name | Fremont Medical Center, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 30 W Main St, Saint Anthony, Idaho |
| Authorized Official Name and Position | Jamie Gudmunson (OWNER/ NURSE PRACTITIONER) |
| Authorized Official Contact | 2086242969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fremont Medical Center, Pllc 30 W Main St Saint Anthony ID 83445-2113 Ph: (208) 624-2969 | Fremont Medical Center, Pllc 30 W Main St Saint Anthony ID 83445-2113 Ph: (208) 624-2969 |
| NPI Number | 1043931637 |
|---|---|
| Provider Enumeration Date | 09/12/2022 |
| Last Update Date | 12/08/2022 |
| Medicare PECOS PAC ID | 4880062850 |
|---|---|
| Medicare Enrollment ID | O20221122002944 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043931637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Jamie L Gudmunson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669853719 PECOS PAC ID: 3971816448 Enrollment ID: I20150714000351 |
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