| Eric Bennett Pllc | |
|
2775 Channing Way Idaho Falls ID 83404-7510 | |
| (208) 524-0133 | |
| Not Available |
| Full Name | Eric Bennett Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 2775 Channing Way, Idaho Falls, Idaho |
| Authorized Official Name and Position | Eric Bennett (PHYSICIAN) |
| Authorized Official Contact | 2083601234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eric Bennett Pllc 2775 Channing Way Idaho Falls ID 83404-7510 Ph: (208) 524-0133 | Eric Bennett Pllc 2775 Channing Way Idaho Falls ID 83404-7510 Ph: (208) 524-0133 |
| NPI Number | 1477153120 |
|---|---|
| Provider Enumeration Date | 10/30/2020 |
| Last Update Date | 10/30/2020 |
| Medicare PECOS PAC ID | 9830501766 |
|---|---|
| Medicare Enrollment ID | O20201216003035 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477153120 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Eric Bennett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083155337 PECOS PAC ID: 2860743564 Enrollment ID: I20201216003069 |
| Provider Name | Jonathan William Rozack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255429288 PECOS PAC ID: 9234433954 Enrollment ID: I20210216002411 |
| Provider Name | Luisa A. Hiendlmayr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730474602 PECOS PAC ID: 1254563372 Enrollment ID: I20220427000170 |
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