Mountain West Medical Services Pllc | |
1067 S Wells St Suite#110 Meridian ID 83642-7997 | |
(208) 229-8739 | |
(208) 895-8540 |
Full Name | Mountain West Medical Services Pllc |
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Speciality | Clinic/Center |
Location | 1067 S Wells St, Meridian, Idaho |
Authorized Official Name and Position | John Kenneth Mcrae (DR. OF NURSE PRACTIONER) |
Authorized Official Contact | 2082298739 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mountain West Medical Services Pllc 1067 S Wells St Suite#110 Meridian ID 83642-7997 Ph: (208) 229-8739 | Mountain West Medical Services Pllc 1067 S Wells St Suite#110 Meridian ID 83642-7997 Ph: (208) 229-8739 |
NPI Number | 1457894339 |
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Provider Enumeration Date | 11/28/2016 |
Last Update Date | 07/07/2023 |
Medicare PECOS PAC ID | 2567734668 |
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Medicare Enrollment ID | O20170824001930 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457894339 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | 54169 (Idaho) | Primary |
Provider Name | John Mcrae |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1750838504 PECOS PAC ID: 1456623552 Enrollment ID: I20170913003436 |
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