| East To West Family Medicine | |
|
2051a E Summersweet Dr Boise ID 83716 | |
| (208) 908-1041 | |
| Not Available |
| Full Name | East To West Family Medicine |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2051a E Summersweet Dr, Boise, Idaho |
| Authorized Official Name and Position | Kathleen Lewis (MANAGER) |
| Authorized Official Contact | 2089558215 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East To West Family Medicine 2051a E Summersweet Dr Boise ID 83716-6695 Ph: (208) 395-1090 | East To West Family Medicine 2051a E Summersweet Dr Boise ID 83716 Ph: (208) 908-1041 |
| NPI Number | 1801393616 |
|---|---|
| Provider Enumeration Date | 04/09/2018 |
| Last Update Date | 06/16/2018 |
| Medicare PECOS PAC ID | 0143578674 |
|---|---|
| Medicare Enrollment ID | O20180731002910 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801393616 | NPI | - | NPPES |
| 1265834311 | Medicaid | ID |
| Provider Name | Leanna Moser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265834311 PECOS PAC ID: 3779808381 Enrollment ID: I20150202001278 |
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