| Snake River Pediatrics, Pc | |
|
1100 Nw 12th St Fruitland ID 83619-5040 | |
| (208) 452-6556 | |
| (541) 216-6557 |
| Full Name | Snake River Pediatrics, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1100 Nw 12th St, Fruitland, Idaho |
| Authorized Official Name and Position | Matthew Joseph Berria (PRESIDENT) |
| Authorized Official Contact | 2087404518 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Snake River Pediatrics, Pc 1100 Nw 12th St Fruitland ID 83619-5040 Ph: (208) 452-6556 | Snake River Pediatrics, Pc 1100 Nw 12th St Fruitland ID 83619-5040 Ph: (208) 452-6556 |
| NPI Number | 1720489396 |
|---|---|
| Provider Enumeration Date | 09/14/2014 |
| Last Update Date | 08/16/2023 |
| Medicare PECOS PAC ID | 0840513032 |
|---|---|
| Medicare Enrollment ID | O20240219001207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720489396 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | PA00913 (Oregon) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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