| Pioneer Family Medicine Pllc | |
|
4740 N. Penngrove Way Ste. 100 Meridian ID 83646 | |
| (208) 938-3663 | |
| (208) 938-3664 |
| Full Name | Pioneer Family Medicine Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 4740 N. Penngrove Way, Meridian, Idaho |
| Authorized Official Name and Position | Jason Scott Ludwig (OWNER) |
| Authorized Official Contact | 2089383663 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pioneer Family Medicine Pllc 4740 N. Penngrove Way Ste. 100 Meridian ID 83646 Ph: (208) 938-3663 | Pioneer Family Medicine Pllc 4740 N. Penngrove Way Ste. 100 Meridian ID 83646 Ph: (208) 938-3663 |
| NPI Number | 1952335929 |
|---|---|
| Provider Enumeration Date | 07/10/2006 |
| Last Update Date | 08/23/2019 |
| Medicare PECOS PAC ID | 5193877850 |
|---|---|
| Medicare Enrollment ID | O20090710000464 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952335929 | NPI | - | NPPES |
| 806456700 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | O-253 (Idaho) | Primary |
| Provider Name | Natalie A Domangue-shiflett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376510123 PECOS PAC ID: 3072501972 Enrollment ID: I20071026000578 |
| Provider Name | Josie F Farmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730414947 PECOS PAC ID: 4385784875 Enrollment ID: I20091214000579 |
| Provider Name | Aaron D Moorhouse |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689602914 PECOS PAC ID: 6901958669 Enrollment ID: I20120124000659 |
| Provider Name | Jason Ludwig |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144258534 PECOS PAC ID: 6901824572 Enrollment ID: I20120124000927 |
| Provider Name | Scott Donald Willoughby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457897852 PECOS PAC ID: 1951685866 Enrollment ID: I20170221000909 |
| Provider Name | Scot Klein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174169254 PECOS PAC ID: 8325477524 Enrollment ID: I20200409002613 |
| Provider Name | Tracy A Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396369138 PECOS PAC ID: 2365860178 Enrollment ID: I20200803002361 |
| Provider Name | Taylor Emery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750969770 PECOS PAC ID: 2062819048 Enrollment ID: I20210916003516 |
| Provider Name | Keylee J Norman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760195978 PECOS PAC ID: 7911364773 Enrollment ID: I20230609000540 |
| Provider Name | Michelle Lynne Miles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992488878 PECOS PAC ID: 4981053832 Enrollment ID: I20231218001932 |
| Provider Name | Brittany Bowerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760124747 PECOS PAC ID: 8527440130 Enrollment ID: I20240326002218 |
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