Salmon River Clinic | |
1 Niece Avenue Stanley ID 83278-0129 | |
(208) 774-3565 | |
Not Available |
Full Name | Salmon River Clinic |
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Speciality | Family Medicine |
Location | 1 Niece Avenue, Stanley, Idaho |
Authorized Official Name and Position | Amy Mercantini Klingler (PA/ADMINISTRATOR) |
Authorized Official Contact | 2087743565 |
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 Po Box 129 Stanley ID 83278-0129 Ph: (208) 774-3565 | Salmon River Clinic 1 Niece Avenue Stanley ID 83278-0129 Ph: (208) 774-3565 |
NPI Number | 1083796569 |
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Provider Enumeration Date | 10/20/2006 |
Last Update Date | 11/21/2012 |
Medicare PECOS PAC ID | 6204745078 |
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Medicare Enrollment ID | O20030425000035 |
Identifier | Type | State | Issuer |
---|---|---|---|
1083796569 | NPI | - | NPPES |
806387200 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | M-4162 (Idaho) | Primary |
363A00000X | Physician Assistant | PA-492 (Idaho) | Secondary |