Salmon River Clinic | |
102 Courthouse Dr Suite F Salmon ID 83467-3904 | |
(208) 742-1111 | |
(208) 742-1120 |
Full Name | Salmon River Clinic |
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Speciality | Clinic/Center |
Location | 102 Courthouse Dr, Salmon, Idaho |
Authorized Official Name and Position | Darci Neyman (OFFICE MANAGER) |
Authorized Official Contact | 2089402524 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Salmon River Clinic 102 Courthouse Dr Suite F Salmon ID 83467-3904 Ph: (208) 742-1111 | Salmon River Clinic 102 Courthouse Dr Suite F Salmon ID 83467-3904 Ph: (208) 742-1111 |
NPI Number | 1104351972 |
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Provider Enumeration Date | 04/28/2017 |
Last Update Date | 04/28/2017 |
Medicare PECOS PAC ID | 4587941620 |
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Medicare Enrollment ID | O20170427001778 |
Identifier | Type | State | Issuer |
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1104351972 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | NP1202A (Idaho) | Primary |
Provider Name | Myllissa M Wyatt |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730439266 PECOS PAC ID: 8729230503 Enrollment ID: I20121129000501 |
Provider Name | Jennie L Brumfield |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811369689 PECOS PAC ID: 7214238963 Enrollment ID: I20151222001567 |
Provider Name | John D Pena |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730787482 PECOS PAC ID: 6103238670 Enrollment ID: I20201208001184 |
Provider Name | Monica Lena White |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1548772338 PECOS PAC ID: 0749699940 Enrollment ID: I20210429000853 |
Provider Name | Jennifer Ann Hill |
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Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1003477357 PECOS PAC ID: 4880063379 Enrollment ID: I20221205002170 |
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