Proactive Wound Care Id Inc. is a medicare enrolled "Podiatrist" provider in Fish Haven, Idaho. Their current practice location is
2270 Highway 89, Fish Haven, Idaho. You can reach out to their office (for appointments etc.) via phone at
(801) 815-6862.
Proactive Wound Care Id Inc. is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Proactive Wound Care Id Inc.
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1134928419.
Healthcare Provider's Profile
| Full Name | Proactive Wound Care Id Inc. |
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| Type | Facility |
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| Speciality | Podiatrist |
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| Location | 2270 Highway 89, Fish Haven, Idaho |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1134928419
- Provider Enumeration Date: 03/10/2025
- Last Update Date: 03/10/2025
Medicare PECOS Information:
- PECOS PAC ID: 4082132139
- Enrollment ID: O20250513002545
Medical Identifiers
Medical identifiers for Proactive Wound Care Id Inc. such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1134928419 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 213E00000X | Podiatrist | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Proactive Wound Care Id Inc. acts as a billing entity for following providers:
| Provider Name | Maryanne Frances Hunt |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1497534002
PECOS PAC ID: 9537603378
Enrollment ID: I20250522000975 |
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| Provider Name | Nathan Brian Payne |
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| Provider Type | Practitioner - Podiatry |
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| Provider Identifiers | NPI Number: 1760845473
PECOS PAC ID: 5193018976
Enrollment ID: I20250606003139 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Proactive Wound Care Id Inc. is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Proactive Wound Care Id Inc.
Po Box 607,
Centerville, UT 84014-0607
Ph: (801) 815-6862 | Proactive Wound Care Id Inc.
2270 Highway 89,
Fish Haven, ID 83287-5139
Ph: (801) 815-6862 |
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