Syringa Primary Care Clinic | |
607 W Main St Grangeville ID 83530-1345 | |
(208) 983-1700 | |
(208) 983-2114 |
Full Name | Syringa Primary Care Clinic |
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Speciality | Clinic/Center |
Location | 607 W Main St, Grangeville, Idaho |
Authorized Official Name and Position | Betty Watson (CFO) |
Authorized Official Contact | 2089831700 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Syringa Primary Care Clinic 722 W North St Grangeville ID 83530-1350 Ph: (208) 983-8590 | Syringa Primary Care Clinic 607 W Main St Grangeville ID 83530-1345 Ph: (208) 983-1700 |
NPI Number | 1073802492 |
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Provider Enumeration Date | 04/06/2011 |
Last Update Date | 03/03/2014 |
Medicare PECOS PAC ID | 6800707530 |
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Medicare Enrollment ID | O20110323000892 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073802492 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 18 (Idaho) | Primary |
Provider Name | James Shen |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1518306372 PECOS PAC ID: 0749506038 Enrollment ID: I20221018002223 |
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