| Sandpoint Super Drug Clinical Services | |
|
604 N Fifth Ave Sandpoint ID 83864-1520 | |
| (208) 263-1408 | |
| Not Available |
| Full Name | Sandpoint Super Drug Clinical Services |
|---|---|
| Speciality | Family Medicine |
| Location | 604 N Fifth Ave, Sandpoint, Idaho |
| Authorized Official Name and Position | Scott Porter (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 2082631408 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandpoint Super Drug Clinical Services 604 N Fifth Ave Sandpoint ID 83864-1520 Ph: (208) 263-1408 | Sandpoint Super Drug Clinical Services 604 N Fifth Ave Sandpoint ID 83864-1520 Ph: (208) 263-1408 |
| NPI Number | 1104584739 |
|---|---|
| Provider Enumeration Date | 12/01/2021 |
| Last Update Date | 03/24/2022 |
| Medicare PECOS PAC ID | 6901298454 |
|---|---|
| Medicare Enrollment ID | O20220404001250 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104584739 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 3336C0002X | Pharmacy - Clinic Pharmacy | (* (Not Available)) | Secondary |
| Provider Name | Jill S Stiller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700334737 PECOS PAC ID: 2365723459 Enrollment ID: I20170104000423 |
| Provider Name | Laura Purdy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093058463 PECOS PAC ID: 9133556624 Enrollment ID: I20220404002247 |
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