| M Cole Johnson, Inc | |
|
526 Shoup Ave W Suite E Twin Falls ID 83301-5050 | |
| (208) 733-1112 | |
| (208) 732-1212 |
| Full Name | M Cole Johnson, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 526 Shoup Ave W, Twin Falls, Idaho |
| Authorized Official Name and Position | Mayben Cole Johnson (OWNER) |
| Authorized Official Contact | 2087331112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| M Cole Johnson, Inc 526 Shoup Ave W Suite E Twin Falls ID 83301-5050 Ph: (208) 733-1112 | M Cole Johnson, Inc 526 Shoup Ave W Suite E Twin Falls ID 83301-5050 Ph: (208) 733-1112 |
| NPI Number | 1528261872 |
|---|---|
| Provider Enumeration Date | 06/06/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2062549843 |
|---|---|
| Medicare Enrollment ID | O20100427000852 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528261872 | NPI | - | NPPES |
| 000010137639 | Other | ID | BLUESHIELD |
| S3788 | Other | ID | BLUECROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | O278 (Idaho) | Primary |
| Provider Name | Mayben Cole Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306920202 PECOS PAC ID: 6608958277 Enrollment ID: I20080205000254 |
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