| Fall River Medical, Pllc | |
|
21 Winn Dr Rexburg ID 83440 | |
| (208) 881-5222 | |
| (877) 441-4715 |
| Full Name | Fall River Medical, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 21 Winn Dr, Rexburg, Idaho |
| Authorized Official Name and Position | Austin C Gillette (OWNER) |
| Authorized Official Contact | 2088815222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fall River Medical, Pllc 21 Winn Dr Rexburg ID 83440-5277 Ph: (208) 220-1057 | Fall River Medical, Pllc 21 Winn Dr Rexburg ID 83440 Ph: (208) 881-5222 |
| NPI Number | 1457698987 |
|---|---|
| Provider Enumeration Date | 01/03/2013 |
| Last Update Date | 11/19/2019 |
| Medicare PECOS PAC ID | 4981846698 |
|---|---|
| Medicare Enrollment ID | O20130808000831 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457698987 | NPI | - | NPPES |
| 1083810287 | Other | ID | NPI |
| 1972709103 | Other | ID | NPI |
| Provider Name | Kelly L Dustin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114957362 PECOS PAC ID: 2264583459 Enrollment ID: I20090629000517 |
| Provider Name | Austin C Gillette |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083810287 PECOS PAC ID: 6800912288 Enrollment ID: I20100922000825 |
| Provider Name | Shelby Nordmann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457939563 PECOS PAC ID: 8325440258 Enrollment ID: I20240627004170 |
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