Health West Lava Clinic | |
85 S 5th W Lava Hot Springs ID 83246 | |
(208) 776-5202 | |
(208) 776-5614 |
Full Name | Health West Lava Clinic |
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Speciality | Clinic/Center |
Location | 85 S 5th W, Lava Hot Springs, Idaho |
Authorized Official Name and Position | Mindy Benedetti (CEO) |
Authorized Official Contact | 2082327862 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Health West Lava Clinic Po Box 2377 Pocatello ID 83206-2377 Ph: (208) 232-7862 | Health West Lava Clinic 85 S 5th W Lava Hot Springs ID 83246 Ph: (208) 776-5202 |
NPI Number | 1427057926 |
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Provider Enumeration Date | 07/18/2005 |
Last Update Date | 08/17/2020 |
Medicare PECOS PAC ID | 4981500931 |
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Medicare Enrollment ID | O20061205000494 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427057926 | NPI | - | NPPES |
002446100 | Medicaid | ID | |
88203 | Other | ID | BLUE CROSS CLINIC NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | M7806 (Idaho) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |