| Eagle Family Medicine P a | |
|
100 Cottonwood Ct Suite 100 Eagle ID 83616-6576 | |
| (208) 939-3197 | |
| (208) 939-3263 |
| Full Name | Eagle Family Medicine P a |
|---|---|
| Speciality | Family Medicine |
| Location | 100 Cottonwood Ct, Eagle, Idaho |
| Authorized Official Name and Position | Shawn Christian Nowierski (OWNER) |
| Authorized Official Contact | 2089393197 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle Family Medicine P a 100 Cottonwood Ct Suite 100 Eagle ID 83616-6576 Ph: (208) 939-3197 | Eagle Family Medicine P a 100 Cottonwood Ct Suite 100 Eagle ID 83616-6576 Ph: (208) 939-3197 |
| NPI Number | 1417054693 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 01/05/2015 |
| Medicare PECOS PAC ID | 4486659562 |
|---|---|
| Medicare Enrollment ID | O20060923000035 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417054693 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M-7050 (Idaho) | Primary |
| Provider Name | Shawn C Nowierski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437109089 PECOS PAC ID: 5799767034 Enrollment ID: I20040602000360 |
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