| Aleracare Of Idaho, Inc | |
|
1449 S David Ln Ste 120 Boise ID 83705-3174 | |
| (888) 510-9298 | |
| (888) 589-6495 |
| Full Name | Aleracare Of Idaho, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1449 S David Ln Ste 120, Boise, Idaho |
| Authorized Official Name and Position | Scott Friedman (EXECUTIVE VP) |
| Authorized Official Contact | 4807162399 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aleracare Of Idaho, Inc 4045 E Bell Rd Ste 157 Phoenix AZ 85032-2240 Ph: (888) 510-9298 | Aleracare Of Idaho, Inc 1449 S David Ln Ste 120 Boise ID 83705-3174 Ph: (888) 510-9298 |
| NPI Number | 1255935581 |
|---|---|
| Provider Enumeration Date | 11/27/2020 |
| Last Update Date | 11/28/2022 |
| Medicare PECOS PAC ID | 9133532526 |
|---|---|
| Medicare Enrollment ID | O20210419001713 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255935581 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Timothy J Burns |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245277243 PECOS PAC ID: 2365457330 Enrollment ID: I20210419002400 |
| Provider Name | Somaly Sith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033618293 PECOS PAC ID: 5799103529 Enrollment ID: I20220419000751 |
| Provider Name | Melisa A Schwartz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841921392 PECOS PAC ID: 6103206099 Enrollment ID: I20220709000238 |
| Provider Name | Kyirsty J Bower |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740679356 PECOS PAC ID: 6103230123 Enrollment ID: I20220830002184 |
| Provider Name | Kathryn Russell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568940377 PECOS PAC ID: 2466821467 Enrollment ID: I20221214001774 |
| Provider Name | Bonna R Ormond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093138539 PECOS PAC ID: 0648491043 Enrollment ID: I20230707001332 |
| Provider Name | Jennifer Davidson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730762345 PECOS PAC ID: 9133520273 Enrollment ID: I20231226000681 |
| Provider Name | Natalie Waller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942915137 PECOS PAC ID: 6507228160 Enrollment ID: I20240307001556 |
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