| Dr Andrew Benjamin Vizcarra, MD | |
| 
					810 Sixth Ave, Sandpoint, ID 83864-5396  | |
| (208) 263-7101 | |
| Not Available | 
| Full Name | Dr Andrew Benjamin Vizcarra | 
|---|---|
| Gender | Male | 
| Speciality | Pediatrics | 
| Location | 810 Sixth Ave, Sandpoint, Idaho | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1629502265 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 208000000X | Pediatrics | 60530 (Tennessee) | Secondary | 
| 208000000X | Pediatrics | M-17696 (Idaho) | Primary | 
| Entity Name | Boundary Regional Community Health Center Inc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1538447727 PECOS PAC ID: 2264341221 Enrollment ID: O20050211000195  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Dr Andrew Benjamin Vizcarra, MD 301 Cedar St Ste 206, Sandpoint, ID 83864-1425 Ph: (208) 637-1012  | Dr Andrew Benjamin Vizcarra, MD 810 Sixth Ave, Sandpoint, ID 83864-5396 Ph: (208) 263-7101  | 
Shannon Marie Seckel, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 420 N 2nd Ave Ste 100, Sandpoint, ID 83864 Phone: 208-265-2242  | |
Mrs. Katherine Magee, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 420 North 2nd Ave, Ste 100, Sandpoint, ID 83864 Phone: 208-265-2242 Fax: 208-265-8214  | |
Dr. John M Seaman, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 420 N 2nd Ave, Sandpoint Pediatrics - Kaniksu Health Services, Sandpoint, ID 83864 Phone: 208-265-2242  | |
Harry Ralph Vanderwal Jr., MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 420 N 2nd Ave, Ste 100, Sandpoint, ID 83864 Phone: 208-265-2242 Fax: 208-265-8214  |