Full Name | |
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Speciality | Clinic/Center |
Location | 31 E Davis, Santa, Idaho |
Authorized Official Name and Position | Amie Scheinost (OWNER) |
Authorized Official Contact | 2082456997 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 61 Santa ID 83866-0061 Ph: (208) 582-1737 | 31 E Davis Santa ID 83866 Ph: (208) 245-6997 |
NPI Number | 1124618079 |
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Provider Enumeration Date | 01/25/2021 |
Last Update Date | 06/26/2024 |
Medicare PECOS PAC ID | 4880084417 |
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Medicare Enrollment ID | O20211214000692 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124618079 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Amie L Scheinost |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1720582638 PECOS PAC ID: 7214288331 Enrollment ID: I20180927003200 |