| Meridian Family Medicine | |
|
1525 E Leighfield Dr Suite 150 Meridian ID 83646-5371 | |
| (208) 888-1199 | |
| (208) 888-0807 |
| Full Name | Meridian Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1525 E Leighfield Dr, Meridian, Idaho |
| Authorized Official Name and Position | David J Butuk (OWNER) |
| Authorized Official Contact | 2088881199 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meridian Family Medicine Po Box 44440 Boise ID 83711-0440 Ph: (208) 888-1199 | Meridian Family Medicine 1525 E Leighfield Dr Suite 150 Meridian ID 83646-5371 Ph: (208) 888-1199 |
| NPI Number | 1710174800 |
|---|---|
| Provider Enumeration Date | 10/02/2007 |
| Last Update Date | 10/02/2007 |
| Medicare PECOS PAC ID | 5698669422 |
|---|---|
| Medicare Enrollment ID | O20040211001072 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710174800 | NPI | - | NPPES |
| 806698100 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | David J Butuk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942250972 PECOS PAC ID: 5193619922 Enrollment ID: I20040224000214 |
| Provider Name | Meredith Mangum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740663657 PECOS PAC ID: 6709194830 Enrollment ID: I20151008002877 |
| Provider Name | Shauna Lynn Lacow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609396282 PECOS PAC ID: 9234405713 Enrollment ID: I20171027002462 |
| Provider Name | Janelle Tyler Barney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508181900 PECOS PAC ID: 5092847061 Enrollment ID: I20180824001672 |
| Provider Name | Jami B Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225161839 PECOS PAC ID: 7719085166 Enrollment ID: I20210303001499 |
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