Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 201 Main, Marsing, 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 |
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Po Box 9 Nampa ID 83653-0009 Ph: (208) 461-7149 | 201 Main Marsing ID 83639 Ph: (208) 896-4159 |
NPI Number | 1861406571 |
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Provider Enumeration Date | 07/28/2006 |
Last Update Date | 02/06/2024 |
Medicare PECOS PAC ID | 4082527353 |
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Medicare Enrollment ID | O20100806000217 |
Identifier | Type | State | Issuer |
---|---|---|---|
1861406571 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |