| Bore Llc | |
|
1498 Midway Ave Ste 2 Ammon ID 83406-4587 | |
| (208) 529-9930 | |
| Not Available |
| Full Name | Bore Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1498 Midway Ave Ste 2, Ammon, Idaho |
| Authorized Official Name and Position | Heather Fumich (CONTRACTING) |
| Authorized Official Contact | 5035020655 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bore Llc 1498 Midway Ave Ste 2 Ammon ID 83406-4587 Ph: () - | Bore Llc 1498 Midway Ave Ste 2 Ammon ID 83406-4587 Ph: (208) 529-9930 |
| NPI Number | 1447880570 |
|---|---|
| Provider Enumeration Date | 01/16/2020 |
| Last Update Date | 01/16/2020 |
| Medicare PECOS PAC ID | 9133556590 |
|---|---|
| Medicare Enrollment ID | O20200224002432 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447880570 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Brian D Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922413699 PECOS PAC ID: 9234432675 Enrollment ID: I20180123003465 |
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