| Ashley A Davis M.d.p.c. | |
|
222 N 2nd St Suite 204 Boise ID 83702-6109 | |
| (208) 429-9100 | |
| (208) 429-9118 |
| Full Name | Ashley A Davis M.d.p.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 222 N 2nd St, Boise, Idaho |
| Authorized Official Name and Position | Ashley A Davis (PRESIDENT) |
| Authorized Official Contact | 2084299100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ashley A Davis M.d.p.c. Po Box 44613 Boise ID 83711-0613 Ph: (208) 429-9100 | Ashley A Davis M.d.p.c. 222 N 2nd St Suite 204 Boise ID 83702-6109 Ph: (208) 429-9100 |
| NPI Number | 1306970827 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0547204695 |
|---|---|
| Medicare Enrollment ID | O20050620000335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306970827 | NPI | - | NPPES |
| 8L097 | Other | ID | BLUE CROSS OF IDAHO |
| 000010151197 | Other | ID | REGENCE BLUE SHIELD OF ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ashley A Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437180841 PECOS PAC ID: 7618911769 Enrollment ID: I20050623000842 |
| Provider Name | Tara Helm Debardeleben |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265828230 PECOS PAC ID: 6305157900 Enrollment ID: I20220308000206 |
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