| Pure Healthcare Of Idaho Llc | |
|
5975 W Overland Rd Boise ID 83709-3012 | |
| (208) 488-4998 | |
| Not Available |
| Full Name | Pure Healthcare Of Idaho Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5975 W Overland Rd, Boise, Idaho |
| Authorized Official Name and Position | Rachel Fraga (CONTRACTING MANAGER) |
| Authorized Official Contact | 8019216325 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pure Healthcare Of Idaho Llc 4179 S Riverboat Rd Ste 220 Taylorsville UT 84123-2986 Ph: (801) 755-3387 | Pure Healthcare Of Idaho Llc 5975 W Overland Rd Boise ID 83709-3012 Ph: (208) 488-4998 |
| NPI Number | 1568005809 |
|---|---|
| Provider Enumeration Date | 10/18/2019 |
| Last Update Date | 03/16/2023 |
| Medicare PECOS PAC ID | 2163852534 |
|---|---|
| Medicare Enrollment ID | O20200427001080 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568005809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Travis Frogley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518508928 PECOS PAC ID: 9335560705 Enrollment ID: I20200611000640 |
| Provider Name | Robert K Mannel |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1093073181 PECOS PAC ID: 1658683073 Enrollment ID: I20240322000609 |
| Provider Name | Abigail Christine Souza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003499013 PECOS PAC ID: 1355744541 Enrollment ID: I20240606002217 |
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