| Melissa M M Agoudemos, MD | |
|
520 S Eagle Rd, Suite 2204, Meridian, ID 83642-6351 | |
| (208) 336-9188 | |
| (208) 336-2636 |
| Full Name | Melissa M M Agoudemos |
|---|---|
| Gender | Female |
| Speciality | Pediatrics - Pediatric Cardiology |
| Location | 520 S Eagle Rd, Meridian, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518175579 | NPI | - | NPPES |
| 036125447 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | R-8001 (Iowa) | Secondary |
| 2080P0202X | Pediatrics - Pediatric Cardiology | 036-125447 (Illinois) | Primary |
| Entity Name | Saint Alphonsus Regional Medical Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649357716 PECOS PAC ID: 3476462359 Enrollment ID: O20040204001036 |
| 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 |
|---|---|
| Melissa M M Agoudemos, MD 520 S Eagle Rd, Suite 2204, Meridian, ID 83642-6351 Ph: (208) 336-9188 | Melissa M M Agoudemos, MD 520 S Eagle Rd, Suite 2204, Meridian, ID 83642-6351 Ph: (208) 336-9188 |
Kristina Miles, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 2275 S Eagle Rd Ste 120, Meridian, ID 83642 Phone: 208-514-2520 Fax: 208-375-2217 | |
Mrs. Anne E. Riffle, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 3653 N. Locust Grove Road, Meridian, ID 83646 Phone: 208-338-5437 Fax: 208-939-9811 | |
Robert F Adams, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 520 S Eagle Rd, Meridian, ID 83642 Phone: 208-336-9188 | |
Joshua Edwin Albright, Pediatrics Medicare: Medicare Enrolled Practice Location: 1620 S Celebration Ave, Meridian, ID 83642 Phone: 208-884-1030 | |
Lisa M. Barker, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1620 S Celebration Ave, Meridian, ID 83642 Phone: 208-884-1030 | |
Dr. Brian C Birch, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2921 S Meridian Rd, Meridian, ID 83642 Phone: 208-297-7847 Fax: 208-203-0097 | |
Susan C Kim, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 3280 E Lanark Dr, Meridian, ID 83642 Phone: 208-377-4400 Fax: 208-377-4416 |