Jacob L Lufkin, CRNA | |
164 S 5th St, Montpelier, ID 83254-1597 | |
(208) 847-1630 | |
Not Available |
Full Name | Jacob L Lufkin |
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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 |
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1457741167 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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163W00000X | Registered Nurse | 28219682A (Indiana) | Secondary |
367500000X | Nurse Anesthetist, Certified Registered | 57248 (Idaho) | Primary |
Entity Name | Franklin County Medical Center |
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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 |
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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: Not Enrolled in Medicare 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 |