| Brandon Hanley, | |
|
1906 Fairview Ave Ste 350, Caldwell, ID 83605-5425 | |
| (208) 505-2101 | |
| Not Available |
| Full Name | Brandon Hanley |
|---|---|
| Gender | Male |
| Speciality | Family Medicine |
| Location | 1906 Fairview Ave Ste 350, Caldwell, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629508288 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | O-1730 (Idaho) | Primary |
| Entity Name | St Lukes Clinic-treasure Valley Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1326336058 PECOS PAC ID: 4981878402 Enrollment ID: O20111119000045 |
| Mailing Address | Practice Location Address |
|---|---|
| Brandon Hanley, 190 E Bannock St, Boise, ID 83712-6241 Ph: () - | Brandon Hanley, 1906 Fairview Ave Ste 350, Caldwell, ID 83605-5425 Ph: (208) 505-2101 |
Stacy Jane Lamers, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 315 E Elm St Ste 201, Caldwell, ID 83605 Phone: 208-514-2528 Fax: 208-375-2217 | |
Zachary A Leckenby, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 315 E Elm St # 201, Caldwell, ID 83605 Phone: 208-514-2528 | |
Megan A Schwehr, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 808 Cleveland Blvd, Caldwell, ID 83605 Phone: 208-459-1025 Fax: 208-466-5359 | |
Miss J'cinda J'nae Bitters, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 211 E Logan St Ste 301, Caldwell, ID 83605 Phone: 208-459-4667 Fax: 208-459-3372 | |
Graceful Iris Morris, FNP Family Medicine Medicare: Medicare Enrolled Practice Location: 712 Aviation Way, Caldwell, ID 83605 Phone: 208-302-7500 Fax: 208-302-7555 | |
Jessica D Blancett, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 315 E Elm St # 201, Caldwell, ID 83605 Phone: 208-514-2528 | |
Hailey Kim Thu Graviet, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 315 E Elm St # 201, Caldwell, ID 83605 Phone: 208-514-2528 Fax: 208-375-2217 |