| Physicians and Surgeons of Shelley | |
|
275 W Locust St Shelley ID 83274-1230 | |
| (208) 782-2960 | |
| Not Available |
| Full Name | Physicians and Surgeons of Shelley |
|---|---|
| Speciality | Clinic/Center |
| Location | 275 W Locust St, Shelley, Idaho |
| Authorized Official Name and Position | Jacob Erickson (CEO) |
| Authorized Official Contact | 2087853801 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Physicians and Surgeons of Shelley 275 W Locust St Shelley ID 83274-1230 Ph: (208) 782-2960 | Physicians and Surgeons of Shelley 275 W Locust St Shelley ID 83274-1230 Ph: (208) 782-2960 |
| NPI Number | 1366630949 |
|---|---|
| Provider Enumeration Date | 10/09/2007 |
| Last Update Date | 02/11/2021 |
| Certification Date | 02/11/2021 |
| Medicare PECOS PAC ID | 8426149758 |
|---|---|
| Medicare Enrollment ID | O20080414000440 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366630949 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 36 (Idaho) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | () | Secondary |
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