| Two Rivers Medical Clinic, Pa | |
|
683 E 3rd St Weiser ID 83672-2248 | |
| (208) 549-0211 | |
| (208) 549-0104 |
| Full Name | Two Rivers Medical Clinic, Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 683 E 3rd St, Weiser, Idaho |
| Authorized Official Name and Position | Tony Edmondson (CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 2085490211 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Two Rivers Medical Clinic, Pa Po Box 871 Weiser ID 83672-0001 Ph: (208) 549-0211 | Two Rivers Medical Clinic, Pa 683 E 3rd St Weiser ID 83672-2248 Ph: (208) 549-0211 |
| NPI Number | 1376662486 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 04/12/2016 |
| Medicare PECOS PAC ID | 8628065950 |
|---|---|
| Medicare Enrollment ID | O20040428001375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376662486 | NPI | - | NPPES |
| 002756300 | Medicaid | ID | |
| 805040300 | Medicaid | ID | |
| 002756600 | Medicaid | ID | |
| 1376662486 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Selena J Ankarberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497840292 PECOS PAC ID: 5597775759 Enrollment ID: I20060502000776 |
| Provider Name | Suzanna Hubele |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477506053 PECOS PAC ID: 6901907385 Enrollment ID: I20070730000440 |
| Provider Name | Lore B Wootton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649365404 PECOS PAC ID: 6608863832 Enrollment ID: I20100708000900 |
| Provider Name | Elizabeth L Bauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255721361 PECOS PAC ID: 6709185572 Enrollment ID: I20160428001529 |
| Provider Name | Jennifer D Rice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538631189 PECOS PAC ID: 7214278704 Enrollment ID: I20190410001420 |
Family Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 360 E Liberty St, Weiser, ID 83672 Phone: 208-414-1124 Fax: 208-414-0947 | |
Weiser Memorial Hospital Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 645 E. 5th St., Weiser, ID 83672 Phone: 208-549-0370 Fax: 208-549-4146 | |
Family Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 360 E Liberty St, Weiser, ID 83672 Phone: 208-414-1124 Fax: 208-414-0947 | |
Family Medical Center Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 360 E Liberty St, Weiser, ID 83672 Phone: 208-414-1124 Fax: 208-414-0947 |