| Saint Alphonsus Medical Group Fruitland Health Plaza | |
|
910 Nw 16th St Ste 101 Fruitland ID 83619-2265 | |
| (208) 452-6851 | |
| Not Available |
| Full Name | Saint Alphonsus Medical Group Fruitland Health Plaza |
|---|---|
| Speciality | Clinic/Center |
| Location | 910 Nw 16th St, Fruitland, Idaho |
| Authorized Official Name and Position | Brian Lannie Checketts (CFO) |
| Authorized Official Contact | 2083677347 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Saint Alphonsus Medical Group Fruitland Health Plaza 3340 E Goldstone Way Meridian ID 83642-1026 Ph: (208) 367-6275 | Saint Alphonsus Medical Group Fruitland Health Plaza 910 Nw 16th St Ste 101 Fruitland ID 83619-2265 Ph: (208) 452-6851 |
| NPI Number | 1760823397 |
|---|---|
| Provider Enumeration Date | 07/11/2013 |
| Last Update Date | 01/24/2023 |
| Medicare PECOS PAC ID | 1456488899 |
|---|---|
| Medicare Enrollment ID | O20140610001779 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760823397 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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