Northwest Integrative Family Med | |
1110 Polston Ave Ste 1 Post Falls ID 83854 | |
(208) 773-1311 | |
(208) 773-1644 |
Full Name | Northwest Integrative Family Med |
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Speciality | Family Medicine |
Location | 1110 Polston Ave, Post Falls, Idaho |
Authorized Official Name and Position | Michael L. Oglesbay (OWNER/PHYSICIAN) |
Authorized Official Contact | 2087731311 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Northwest Integrative Family Med 3773 W 5th Ave Ste 301 Post Falls ID 83854-6728 Ph: (208) 773-1311 | Northwest Integrative Family Med 1110 Polston Ave Ste 1 Post Falls ID 83854 Ph: (208) 773-1311 |
NPI Number | 1548200181 |
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Provider Enumeration Date | 06/08/2006 |
Last Update Date | 05/02/2019 |
Medicare PECOS PAC ID | 8729343330 |
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Medicare Enrollment ID | O20180601001315 |
Identifier | Type | State | Issuer |
---|---|---|---|
1548200181 | NPI | - | NPPES |
806345800 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | M8602 (Idaho) | Primary |
Provider Name | Michael Lee Oglesbay |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1659476844 PECOS PAC ID: 5597651844 Enrollment ID: I20180629000504 |
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