Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 150 2nd St, Melba, Idaho |
Authorized Official Name and Position | Donald Curtis (DIRECTOR OF REVENUE) |
Authorized Official Contact | 2083239613 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 9 Nampa ID 83653-0009 Ph: (208) 461-7149 | 150 2nd St Melba ID 83641-5199 Ph: (208) 495-1011 |
NPI Number | 1578574521 |
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Provider Enumeration Date | 08/11/2006 |
Last Update Date | 02/06/2024 |
Medicare PECOS PAC ID | 4082527353 |
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Medicare Enrollment ID | O20100806000171 |
Identifier | Type | State | Issuer |
---|---|---|---|
1578574521 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |