| Jcw Psychiatry Pllc | |
|
413 N Allumbaugh St Ste 101 Boise ID 83704-9219 | |
| (208) 323-1125 | |
| (208) 323-9604 |
| Full Name | Jcw Psychiatry Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 413 N Allumbaugh St Ste 101, Boise, Idaho |
| Authorized Official Name and Position | Cheri Peterson (CREDENTIALER) |
| Authorized Official Contact | 2089545594 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jcw Psychiatry Pllc 413 N Allumbaugh St Ste 101 Boise ID 83704-9219 Ph: (208) 323-1125 | Jcw Psychiatry Pllc 413 N Allumbaugh St Ste 101 Boise ID 83704-9219 Ph: (208) 323-1125 |
| NPI Number | 1861001687 |
|---|---|
| Provider Enumeration Date | 07/28/2020 |
| Last Update Date | 07/28/2020 |
| Certification Date | 07/28/2020 |
| Medicare PECOS PAC ID | 1254751878 |
|---|---|
| Medicare Enrollment ID | O20201021001015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861001687 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Jacob Christopher White |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831506351 PECOS PAC ID: 2062790967 Enrollment ID: I20190830001322 |
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