| Glenns Ferry Health Center, Inc. | |
|
486 W 1st Ave Glenns Ferry ID 83623-2701 | |
| (208) 366-7416 | |
| (208) 587-3324 |
| Full Name | Glenns Ferry Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 486 W 1st Ave, Glenns Ferry, Idaho |
| Authorized Official Name and Position | Amber E Jordan (CEO) |
| Authorized Official Contact | 2086967157 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenns Ferry Health Center, Inc. 120 Desert Sage Way Mountain Home ID 83647-1038 Ph: (208) 587-3398 | Glenns Ferry Health Center, Inc. 486 W 1st Ave Glenns Ferry ID 83623-2701 Ph: (208) 366-7416 |
| NPI Number | 1376673137 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 09/18/2024 |
| Medicare PECOS PAC ID | 5496656894 |
|---|---|
| Medicare Enrollment ID | O20040119000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376673137 | NPI | - | NPPES |
| 002550500 | Medicaid | ID | |
| 002550200 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Idaho) | Primary |
| Provider Name | Saad Hijazi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942410212 PECOS PAC ID: 8628095403 Enrollment ID: I20081211000540 |
| Provider Name | Harry Lazarte |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548486053 PECOS PAC ID: 1456424274 Enrollment ID: I20101105001023 |
| Provider Name | Krzysztof H Ziola |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073692166 PECOS PAC ID: 2961464987 Enrollment ID: I20101122000932 |
| Provider Name | Dawn D Best |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003049925 PECOS PAC ID: 9638327448 Enrollment ID: I20120920000505 |
| Provider Name | Deborah S Glasscock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730415993 PECOS PAC ID: 4587815840 Enrollment ID: I20121114000099 |
| Provider Name | Nicholas J Arbon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174922355 PECOS PAC ID: 3870802499 Enrollment ID: I20151022000882 |
| Provider Name | Heather L King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164895371 PECOS PAC ID: 3274821525 Enrollment ID: I20161019001799 |
| Provider Name | Darin K Gere |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780918268 PECOS PAC ID: 7214202928 Enrollment ID: I20171005002597 |
| Provider Name | Jamie Coffey Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992135818 PECOS PAC ID: 5597020842 Enrollment ID: I20180607001888 |
| Provider Name | Katherine A Gray |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427407824 PECOS PAC ID: 9739446568 Enrollment ID: I20200107002738 |
| Provider Name | Cynthia G Medrano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053703504 PECOS PAC ID: 2769796291 Enrollment ID: I20200114003307 |
| Provider Name | Paulette A Flores |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982917472 PECOS PAC ID: 8325214026 Enrollment ID: I20200123002531 |
| Provider Name | Adriana Crompton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184104697 PECOS PAC ID: 2466817507 Enrollment ID: I20230425002295 |
| Provider Name | Melinda Carpenter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013469808 PECOS PAC ID: 0042650103 Enrollment ID: I20240506004807 |
| Provider Name | Adria R Probst |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700664554 PECOS PAC ID: 7719412238 Enrollment ID: I20241120004703 |
| Provider Name | Andrea R Wood |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396571907 PECOS PAC ID: 6002341807 Enrollment ID: I20241202003508 |
| Provider Name | Charlene E Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144621756 PECOS PAC ID: 8123240926 Enrollment ID: I20250114000223 |
Glenns Ferry Health Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 486 W 1st Ave, Glenns Ferry, ID 83623 Phone: 208-366-7416 Fax: 208-366-2595 |