| Total Life Clinic Pllc | |
|
2311 Park Ave Unit 2 Suite 6&8 Burley ID 83318-2104 | |
| (208) 878-6413 | |
| (208) 878-6417 |
| Full Name | Total Life Clinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2311 Park Ave, Burley, Idaho |
| Authorized Official Name and Position | Shelbyann Bernice Aldridge (OFFICE MANAGER) |
| Authorized Official Contact | 2088786413 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Total Life Clinic Pllc 2311 Park Ave Unit 2 Suite 6&8 Burley ID 83318-2104 Ph: (208) 878-6413 | Total Life Clinic Pllc 2311 Park Ave Unit 2 Suite 6&8 Burley ID 83318-2104 Ph: (208) 878-6413 |
| NPI Number | 1467816199 |
|---|---|
| Provider Enumeration Date | 04/08/2016 |
| Last Update Date | 03/16/2023 |
| Medicare PECOS PAC ID | 6305121336 |
|---|---|
| Medicare Enrollment ID | O20170314001070 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467816199 | NPI | - | NPPES |
| 1467816199 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lacie S Asher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609107176 PECOS PAC ID: 5799978607 Enrollment ID: I20101025000230 |
| Provider Name | Blake Taylor Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649739392 PECOS PAC ID: 7214333533 Enrollment ID: I20210910001680 |
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