| Irving Middle School | |
|
911 N Grant Ave Pocatello ID 83204-2847 | |
| (208) 232-7862 | |
| Not Available |
| Full Name | Irving Middle School |
|---|---|
| Speciality | Clinic/Center |
| Location | 911 N Grant Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Amelia Murphy (MEDICAL STAFF COORDINATOR) |
| Authorized Official Contact | 2082327862 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Irving Middle School 500 S 11th Ave Ste 400 Pocatello ID 83201-4880 Ph: () - | Irving Middle School 911 N Grant Ave Pocatello ID 83204-2847 Ph: (208) 232-7862 |
| NPI Number | 1518519255 |
|---|---|
| Provider Enumeration Date | 07/12/2019 |
| Last Update Date | 08/12/2019 |
| Medicare PECOS PAC ID | 4981500931 |
|---|---|
| Medicare Enrollment ID | O20191107000488 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518519255 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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