| Primary Care Specialists, Pa | |
|
110 Vista Drive Pocatello ID 83201 | |
| (208) 234-2300 | |
| (208) 234-0026 |
| Full Name | Primary Care Specialists, Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 110 Vista Drive, Pocatello, Idaho |
| Authorized Official Name and Position | Mark L Mansfield (PRESIDENT) |
| Authorized Official Contact | 2082342300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Specialists, Pa 110 Vista Drive Pocatello ID 83201 Ph: (208) 234-2300 | Primary Care Specialists, Pa 110 Vista Drive Pocatello ID 83201 Ph: (208) 234-2300 |
| NPI Number | 1508875881 |
|---|---|
| Provider Enumeration Date | 08/05/2006 |
| Last Update Date | 09/18/2012 |
| Medicare PECOS PAC ID | 4082699574 |
|---|---|
| Medicare Enrollment ID | O20210323002420 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508875881 | NPI | - | NPPES |
| 805105400 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Richard M Maynard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952395063 PECOS PAC ID: 1658356167 Enrollment ID: I20040907001278 |
| Provider Name | Mark L Mansfield |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134113251 PECOS PAC ID: 3072531276 Enrollment ID: I20051111000116 |
| Provider Name | Codie M Robertson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134477870 PECOS PAC ID: 7214178318 Enrollment ID: I20130801000652 |
| Provider Name | Jordan R Stevens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851839542 PECOS PAC ID: 9032493101 Enrollment ID: I20170309001079 |
| Provider Name | Nathan T Rowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114504594 PECOS PAC ID: 3274935671 Enrollment ID: I20210707003555 |
Community Care, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1595 Yellowstone Ave, Pocatello, ID 83201 Phone: 208-233-0032 | |
Family Medical Clinic Of Chubbuck Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 476 E Chubbuck Rd, Pocatello, ID 83202 Phone: 208-233-9898 Fax: 208-232-8566 | |
Superior Physical Therapy Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1800 Flandro Dr Ste 190, Pocatello, ID 83202 Phone: 208-233-2248 | |
Health West, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1001 N 7th Ave Ste 135, Pocatello, ID 83201 Phone: 208-232-7862 | |
Health West, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 955 W Alameda Rd, Pocatello, ID 83201 Phone: 208-237-2233 | |
Idaho Sports & Spine Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 950 Hospital Way, Ste A, Pocatello, ID 83201 Phone: 208-478-4522 Fax: 208-478-2935 | |
Mountain View Family Medicine, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2006 Birdie Thompson Dr, Pocatello, ID 83201 Phone: 208-232-1132 Fax: 208-232-1134 |