| Innovative Family Medicine Of Idaho Pllc | |
|
512 Pole Line Rd Ste 2 Twin Falls ID 83301-6367 | |
| (208) 735-3636 | |
| (208) 735-3637 |
| Full Name | Innovative Family Medicine Of Idaho Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 512 Pole Line Rd Ste 2, Twin Falls, Idaho |
| Authorized Official Name and Position | Aaron Brown (MEMBER) |
| Authorized Official Contact | 2089610420 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Family Medicine Of Idaho Pllc Po Box 44953 Boise ID 83711-0953 Ph: () - | Innovative Family Medicine Of Idaho Pllc 512 Pole Line Rd Ste 2 Twin Falls ID 83301-6367 Ph: (208) 735-3636 |
| NPI Number | 1811689870 |
|---|---|
| Provider Enumeration Date | 05/25/2023 |
| Last Update Date | 04/02/2024 |
| Medicare PECOS PAC ID | 2668820556 |
|---|---|
| Medicare Enrollment ID | O20240213003613 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811689870 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Aaron B Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326128612 PECOS PAC ID: 7214039031 Enrollment ID: I20081018000206 |
| Provider Name | Aaron E Packham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912356718 PECOS PAC ID: 4486946266 Enrollment ID: I20190327001620 |
| Provider Name | Jared R Henderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336597152 PECOS PAC ID: 0648563403 Enrollment ID: I20190618001797 |
| Provider Name | Marc Allan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073043337 PECOS PAC ID: 6103195920 Enrollment ID: I20200626001845 |
| Provider Name | Jonathan R Muretisch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023543899 PECOS PAC ID: 9133499932 Enrollment ID: I20200716002336 |
| Provider Name | Alexis Anne Gough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497426415 PECOS PAC ID: 5193115814 Enrollment ID: I20211210001943 |
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