| Jacob L Lufkin, CRNA | |
|
164 S 5th St, Montpelier, ID 83254-1597 | |
| (208) 847-1630 | |
| Not Available |
| Full Name | Jacob L Lufkin |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 164 S 5th St, Montpelier, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457741167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163W00000X | Registered Nurse | 28219682A (Indiana) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 57248 (Idaho) | Primary |
| Entity Name | Franklin County Medical Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1548355811 PECOS PAC ID: 8820909104 Enrollment ID: O20070917000547 |
| Mailing Address | Practice Location Address |
|---|---|
| Jacob L Lufkin, CRNA 123 Valley View Dr, Montpelier, ID 83254-1529 Ph: (208) 604-5009 | Jacob L Lufkin, CRNA 164 S 5th St, Montpelier, ID 83254-1597 Ph: (208) 847-1630 |
Gary Scott Griffin, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 164 South 5th, Montpelier, ID 83254 Phone: 208-847-1630 Fax: 208-847-4425 | |
Dorian S Grunig, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 164 South 5th, Montpelier, ID 83254 Phone: 208-390-7757 Fax: 208-847-4425 |