| Upper Valley Family Practice, Pllc | |
|
32 W 1st S Rexburg ID 83440-1810 | |
| (208) 356-8883 | |
| (208) 656-0292 |
| Full Name | Upper Valley Family Practice, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 32 W 1st S, Rexburg, Idaho |
| Authorized Official Name and Position | Jeffrey G Hopkin (OWNER/ PHYSICAN) |
| Authorized Official Contact | 2083568883 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Upper Valley Family Practice, Pllc 32 W 1st S Rexburg ID 83440-1810 Ph: (208) 356-8883 | Upper Valley Family Practice, Pllc 32 W 1st S Rexburg ID 83440-1810 Ph: (208) 356-8883 |
| NPI Number | 1922237874 |
|---|---|
| Provider Enumeration Date | 07/13/2009 |
| Last Update Date | 04/19/2018 |
| Medicare PECOS PAC ID | 1759433675 |
|---|---|
| Medicare Enrollment ID | O20090723000252 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922237874 | NPI | - | NPPES |
| 003727500 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M-6910 (Idaho) | Primary |
| Provider Name | Jeffrey G Hopkin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780797712 PECOS PAC ID: 3274522149 Enrollment ID: I20040507000379 |
| Provider Name | Jamie L Gudmunson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669853719 PECOS PAC ID: 3971816448 Enrollment ID: I20150714000351 |
| Provider Name | Robert W Gneiting |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225105919 PECOS PAC ID: 3678709383 Enrollment ID: I20170105001130 |
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