| Riverside Primary Care Adult And Geriatric Medicine Plllp | |
|
1673 W Shoreline Dr Ste 100 Boise ID 83702-6749 | |
| (208) 593-3054 | |
| Not Available |
| Full Name | Riverside Primary Care Adult And Geriatric Medicine Plllp |
|---|---|
| Speciality | Family Medicine |
| Location | 1673 W Shoreline Dr Ste 100, Boise, Idaho |
| Authorized Official Name and Position | Jessica Long (CO-OWNER) |
| Authorized Official Contact | 2088501940 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverside Primary Care Adult And Geriatric Medicine Plllp 1673 W Shoreline Dr Ste 100 Boise ID 83702-6749 Ph: () - | Riverside Primary Care Adult And Geriatric Medicine Plllp 1673 W Shoreline Dr Ste 100 Boise ID 83702-6749 Ph: (208) 593-3054 |
| NPI Number | 1003693961 |
|---|---|
| Provider Enumeration Date | 09/13/2023 |
| Last Update Date | 09/13/2023 |
| Medicare PECOS PAC ID | 3072969112 |
|---|---|
| Medicare Enrollment ID | O20231026001427 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003693961 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Carla D Dirmann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851624282 PECOS PAC ID: 2961549456 Enrollment ID: I20141203002169 |
| Provider Name | Jessica B Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194244707 PECOS PAC ID: 3577824234 Enrollment ID: I20180221001763 |
| Provider Name | Latonyia Hewett |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1417281908 PECOS PAC ID: 4082739974 Enrollment ID: I20240426003540 |
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