| Dr John Kodatt, MD | |
|
1510 12th Ave Rd Ste 200, Nampa, ID 83686-6946 | |
| (208) 302-6800 | |
| (208) 302-6855 |
| Full Name | Dr John Kodatt |
|---|---|
| Gender | Male |
| Speciality | Family Medicine |
| Location | 1510 12th Ave Rd Ste 200, Nampa, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083354039 | NPI | - | NPPES |
| Entity Name | Southeastern Emergency Physicians Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1356379382 PECOS PAC ID: 2466364997 Enrollment ID: O20050302000285 |
| Entity Name | Southeastern Physician Services Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083835441 PECOS PAC ID: 0042307852 Enrollment ID: O20090715000150 |
| Entity Name | South Central Physicians Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1427611854 PECOS PAC ID: 6507195492 Enrollment ID: O20210126001625 |
| Entity Name | Urgent Care Services Southeast Psc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1427831759 PECOS PAC ID: 0345694766 Enrollment ID: O20231003002701 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr John Kodatt, MD Po Box 190930, Boise, ID 83719-0930 Ph: (208) 302-9342 | Dr John Kodatt, MD 1510 12th Ave Rd Ste 200, Nampa, ID 83686-6946 Ph: (208) 302-6800 |
Dr. Julia Marie Jensen, DO Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 223 16th Ave N, Nampa, ID 83687 Phone: 208-466-7869 Fax: 208-466-5359 | |
Jason Johnston, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 1820 Caldwell Blvd, Nampa, ID 83651 Phone: 208-466-6567 Fax: 208-466-7922 | |
Stuart Black, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 223 16th Ave N, Nampa, ID 83687 Phone: 208-466-7869 Fax: 208-466-5359 | |
Heidi Elizabeth Shields, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1150 N Sister Catherine Way, Nampa, ID 83687 Phone: 208-302-7000 Fax: 208-302-7055 | |
Robert B Buxton, D.O. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1510 12th Ave Rd, Ste 200, Nampa, ID 83886 Phone: 208-302-6800 Fax: 208-302-6855 | |
Courtney Scott Isaacs, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 1510 12th Ave Rd Ste 200, Nampa, ID 83686 Phone: 208-302-6800 Fax: 208-302-6855 | |
Jesse Tyler Mcchane, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 207 1st St S, Nampa, ID 83651 Phone: 208-466-7869 Fax: 208-466-5359 |