| Telemental Health Link Llc | |
|
4055 E Blueberry St Meridian ID 83642-8261 | |
| (208) 775-7418 | |
| (208) 647-5008 |
| Full Name | Telemental Health Link Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 4055 E Blueberry St, Meridian, Idaho |
| Authorized Official Name and Position | Susan M Derivas (AO) |
| Authorized Official Contact | 2087757418 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Telemental Health Link Llc 4055 E Blueberry St Meridian ID 83642-8261 Ph: (208) 600-2060 | Telemental Health Link Llc 4055 E Blueberry St Meridian ID 83642-8261 Ph: (208) 775-7418 |
| NPI Number | 1437783529 |
|---|---|
| Provider Enumeration Date | 02/27/2020 |
| Last Update Date | 02/07/2024 |
| Medicare PECOS PAC ID | 4587062336 |
|---|---|
| Medicare Enrollment ID | O20211007002826 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437783529 | NPI | - | NPPES |
| 396453OSMIND | Other | CHANGE HEALTHCARE MASTER BILLING ID | |
| 58322 | Other | NM | NURSING LICENSE |
| 58322 | Other | NM | NEW MEXICO APRN CNP LICENSE |
| 020837 | Medicaid | ID | |
| 13961493 | Other | CAQH ID | |
| 64266 | Other | ID | NURSING LICENSE |
| 03962 | Other | LA | NURSING LICENSE |
| 1529234 | Other | NCSBN ID | |
| 0364158 | Other | ANCC CERTIFICATION NO. | |
| 363LP0808X | Other | LA | TAXONOMIES: NURSE PRACTITIONER PSYCH MENTAL HEALTH |
| P69441 | Other | LA | UPIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Susan M Derivas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851493829 PECOS PAC ID: 2264512011 Enrollment ID: I20211012003126 |
Jared M Furgeson Dds Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2700 W Cherry Ln, Suite 120, Meridian, ID 83642 Phone: 208-887-9000 | |
Hampton Roads Medical Specialists Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2131 S Bonito Way, Meridian, ID 83642 Phone: 208-489-9500 | |
Vast Durable Medical Equipment Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2985 S Meridian Rd Ste 140, Meridian, ID 83642 Phone: 208-860-2849 | |
Borron Family Medicine Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 790 W Ustick Rd, Ste 110, Meridian, ID 83646 Phone: 208-639-3990 Fax: 208-639-3992 | |
Primary Health Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1623 South Wells Avenue, Meridian, ID 83642 Phone: 208-489-1450 Fax: 208-489-1451 | |
Virtare Health Physician Services Of Idaho Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3597 E Monarch Sky Ln Ste 240, Meridian, ID 83646 Phone: 855-745-8400 | |
Terry Reilly Health Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3115 E Florence Dr, Meridian, ID 83642 Phone: 208-932-8992 Fax: 208-370-6215 |