| Family Practice By The Lake Llc | |
|
1875 N Lakewood Dr Ste 205 Coeur D Alene ID 83814-4928 | |
| (208) 966-4087 | |
| (208) 966-4031 |
| Full Name | Family Practice By The Lake Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1875 N Lakewood Dr Ste 205, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Jacqueline Lee Wagner (OWNER) |
| Authorized Official Contact | 2086611181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Practice By The Lake Llc 1875 N Lakewood Dr Ste 205 Coeur D Alene ID 83814-4928 Ph: (208) 966-4087 | Family Practice By The Lake Llc 1875 N Lakewood Dr Ste 205 Coeur D Alene ID 83814-4928 Ph: (208) 966-4087 |
| NPI Number | 1295283810 |
|---|---|
| Provider Enumeration Date | 09/12/2016 |
| Last Update Date | 03/25/2024 |
| Medicare PECOS PAC ID | 7113205931 |
|---|---|
| Medicare Enrollment ID | O20161031000460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295283810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Jacqueline L Wagner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447598362 PECOS PAC ID: 7315187093 Enrollment ID: I20140407000617 |
Active Family Healthcare Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 919 W Canfield Ave, Coeur D Alene, ID 83815 Phone: 208-758-0560 Fax: 208-762-5424 | |
Ironwood Family Practice, Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3815 N Schreiber Way Unit 102, Coeur D Alene, ID 83815 Phone: 208-667-4557 Fax: 208-765-2887 | |
North Idaho Endoscopy And Surgical Specialists, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3318 N Grandmill Ln, Coeur D Alene, ID 83814 Phone: 208-292-0445 Fax: 208-772-6514 | |
Cinch Health Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6190 N Sunshine St Ste E, Coeur D Alene, ID 83815 Phone: 208-691-4569 | |
Helping Hands Chiropractic And Wellness Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 116 W Neider Ave Unit 116, Coeur D Alene, ID 83815 Phone: 208-664-0444 Fax: 208-664-0446 | |
Perpetual Family Medicine Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1717 Lincoln Way Ste 108, Coeur D Alene, ID 83814 Phone: 208-480-6174 Fax: 208-601-6174 | |
Head Sport Em Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 980 W Ironwood Dr Ste 206, Coeur D Alene, ID 83814 Phone: 208-512-4334 |