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1115 12th Ave Rd Nampa ID 83686-5738 | |
| (208) 498-1080 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1115 12th Ave Rd, Nampa, Idaho |
| Authorized Official Name and Position | David Peterman (PRESIDENT) |
| Authorized Official Contact | 2089556522 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 191050 Boise ID 83719-1050 Ph: (208) 955-6500 | 1115 12th Ave Rd Nampa ID 83686-5738 Ph: (208) 498-1080 |
| NPI Number | 1851730949 |
|---|---|
| Provider Enumeration Date | 06/21/2013 |
| Last Update Date | 06/21/2013 |
| Medicare PECOS PAC ID | 3971544685 |
|---|---|
| Medicare Enrollment ID | O20150612000567 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851730949 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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