| Helicase Llc | |
|
1717 Arlington Ave Caldwell ID 83605-4802 | |
| (919) 886-0690 | |
| Not Available |
| Full Name | Helicase Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1717 Arlington Ave, Caldwell, Idaho |
| Authorized Official Name and Position | Thadeus Koontz (MD,PHD/OWNER) |
| Authorized Official Contact | 9198860690 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Helicase Llc Po Box 44795 Boise ID 83711-0795 Ph: () - | Helicase Llc 1717 Arlington Ave Caldwell ID 83605-4802 Ph: (919) 886-0690 |
| NPI Number | 1083343388 |
|---|---|
| Provider Enumeration Date | 06/10/2022 |
| Last Update Date | 08/09/2022 |
| Certification Date | 07/28/2022 |
| Medicare PECOS PAC ID | 9032592597 |
|---|---|
| Medicare Enrollment ID | O20220816001259 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083343388 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Thadeus B Koontz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609010156 PECOS PAC ID: 3072757012 Enrollment ID: I20130913000262 |
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