| Michele B Ebbers, MD | |
| 305 E Jefferson St, Boise, ID 83712-6273 | |
| (208) 381-6196 | |
| (208) 381-6199 | 
| Full Name | Michele B Ebbers | 
|---|---|
| Gender | Female | 
| Speciality | Urology - Pediatric Urology | 
| Location | 305 E Jefferson St, Boise, Idaho | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1154358067 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 208800000X | Urology | 2006-00886 (North Carolina) | Secondary | 
| 2088P0231X | Urology - Pediatric Urology | M11717 (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 | 
|---|---|
| Michele B Ebbers, MD 190 E Bannock St, Boise, ID 83712-6241 Ph: (208) 381-2222 | Michele B Ebbers, MD 305 E Jefferson St, Boise, ID 83712-6273 Ph: (208) 381-6196 | 
| Sean Patrick Stroup, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 510 N 2nd St Ste 103, Boise, ID 83702 Phone: 208-381-4700 | |
| Dr. Kara C Taggart, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 510 N 2nd St, Suite 103, Boise, ID 83702 Phone: 208-381-4700 Fax: 208-381-4977 | |
| Dr. Donald E Walker, MD Urology Medicare: Not Enrolled in Medicare Practice Location: 701 E Parkcenter Blvd, Boise, ID 83706 Phone: 208-344-5757 Fax: 208-381-6526 | |
| Robert E. Jackson, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 520 S Eagle Rd, Suite 3112, Boise, ID 83712 Phone: 208-381-2222 | |
| Dr. Edwin Manley Briggs, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 1316 Harrison Blvd, Boise, ID 83702 Phone: 208-345-5523 Fax: 208-389-4606 | |
| Dr. Stephen A. Brassell, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 100 E Idaho St, Boise, ID 83712 Phone: 208-381-2222 |