Full Name | |
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Speciality | Family Medicine |
Location | 313 Hwy 93, Mackay, Idaho |
Authorized Official Name and Position | Brad Huerta (CEO) |
Authorized Official Contact | 2085278206 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 815 Arco ID 83213-0815 Ph: (208) 527-8206 | 313 Hwy 93 Mackay ID 83251 Ph: (208) 588-2993 |
NPI Number | 1760402663 |
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Provider Enumeration Date | 07/20/2006 |
Last Update Date | 05/01/2017 |
Medicare PECOS PAC ID | 7810807427 |
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Medicare Enrollment ID | O20070727000737 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760402663 | NPI | - | NPPES |
804212900 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |