| Prism Family Medicine Llc | |
|
1950 E Clark St Ste 100 Pocatello ID 83201-3315 | |
| (208) 806-4581 | |
| (208) 837-3010 |
| Full Name | Prism Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1950 E Clark St Ste 100, Pocatello, Idaho |
| Authorized Official Name and Position | Jessica J Rolynn (OWNER) |
| Authorized Official Contact | 2088064581 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prism Family Medicine Llc 1950 E Clark St Ste 100 Pocatello ID 83201-3315 Ph: () - | Prism Family Medicine Llc 1950 E Clark St Ste 100 Pocatello ID 83201-3315 Ph: (208) 806-4581 |
| NPI Number | 1942028592 |
|---|---|
| Provider Enumeration Date | 10/02/2024 |
| Last Update Date | 10/03/2024 |
| Medicare PECOS PAC ID | 8527594613 |
|---|---|
| Medicare Enrollment ID | O20241212002767 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942028592 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jessica J Rolynn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821652199 PECOS PAC ID: 0042544165 Enrollment ID: I20221012002109 |
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