| Greene Mountain Medical | |
|
3719 Wheeler Cir Nampa ID 83686-7949 | |
| (208) 695-0388 | |
| (208) 606-3682 |
| Full Name | Greene Mountain Medical |
|---|---|
| Speciality | Clinic/Center |
| Location | 3719 Wheeler Cir, Nampa, Idaho |
| Authorized Official Name and Position | Aimee Elizabeth Shepard (OWNER) |
| Authorized Official Contact | 2086950388 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greene Mountain Medical 3719 Wheeler Cir Nampa ID 83686-7949 Ph: (208) 695-0388 | Greene Mountain Medical 3719 Wheeler Cir Nampa ID 83686-7949 Ph: (208) 695-0388 |
| NPI Number | 1124710009 |
|---|---|
| Provider Enumeration Date | 05/22/2023 |
| Last Update Date | 07/05/2023 |
| Medicare PECOS PAC ID | 8628423621 |
|---|---|
| Medicare Enrollment ID | O20231011002276 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124710009 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Aimee E Elizabeth Shepard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154092427 PECOS PAC ID: 2769874536 Enrollment ID: I20220128000727 |
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