| Indigo Idaho Services, Llc | |
|
2836 N Ramsey Rd Coeur D Alene ID 83815-9002 | |
| (208) 482-3400 | |
| Not Available |
| Full Name | Indigo Idaho Services, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2836 N Ramsey Rd, Coeur D Alene, Idaho |
| Authorized Official Name and Position | William Robertson (PRESIDENT) |
| Authorized Official Contact | 2534031272 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indigo Idaho Services, Llc P.o. Box 5299 Ms: 820-5-pco Tacoma WA 98415-0299 Ph: () - | Indigo Idaho Services, Llc 2836 N Ramsey Rd Coeur D Alene ID 83815-9002 Ph: (208) 482-3400 |
| NPI Number | 1821799263 |
|---|---|
| Provider Enumeration Date | 03/13/2023 |
| Last Update Date | 03/21/2023 |
| Medicare PECOS PAC ID | 1850750373 |
|---|---|
| Medicare Enrollment ID | O20230630002272 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821799263 | NPI | - | NPPES |
| Provider Name | Beaver Eller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760827372 PECOS PAC ID: 7113169335 Enrollment ID: I20171102001587 |
| Provider Name | Michael Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538110911 PECOS PAC ID: 4385638626 Enrollment ID: I20230703000163 |
| Provider Name | Samantha Magby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871839449 PECOS PAC ID: 7810216595 Enrollment ID: I20230703000205 |
| Provider Name | Jillian Mccartney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619313640 PECOS PAC ID: 2466678941 Enrollment ID: I20230703000290 |
| Provider Name | Lindsay Kornelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023318144 PECOS PAC ID: 8921296963 Enrollment ID: I20230703000353 |
| Provider Name | Kimberly Silverman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841782257 PECOS PAC ID: 5799034161 Enrollment ID: I20230703000422 |
| Provider Name | Jacquelyn Brooks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861402224 PECOS PAC ID: 5193717791 Enrollment ID: I20231115000310 |
| Provider Name | Kiley Amanda Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881336030 PECOS PAC ID: 6406238575 Enrollment ID: I20240326001880 |
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