| Idaho Modern Medicine - Pllc | |
|
1000 Pocatello Creek Rd Ste E10 Pocatello ID 83201-2953 | |
| (208) 317-5371 | |
| Not Available |
| Full Name | Idaho Modern Medicine - Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1000 Pocatello Creek Rd Ste E10, Pocatello, Idaho |
| Authorized Official Name and Position | Michael A Anderson (PHYSICIAN / OWNER) |
| Authorized Official Contact | 2086484789 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Modern Medicine - Pllc 1000 Pocatello Creek Rd Ste E10 Pocatello ID 83201-2953 Ph: (208) 648-4789 | Idaho Modern Medicine - Pllc 1000 Pocatello Creek Rd Ste E10 Pocatello ID 83201-2953 Ph: (208) 317-5371 |
| NPI Number | 1184255754 |
|---|---|
| Provider Enumeration Date | 01/31/2020 |
| Last Update Date | 02/05/2024 |
| Medicare PECOS PAC ID | 1557790078 |
|---|---|
| Medicare Enrollment ID | O20200406000007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184255754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Michael A Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124406186 PECOS PAC ID: 2567774045 Enrollment ID: I20180711002506 |
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