| Intermountain Regenerative Medicine | |
|
1075 S Utah Ave Ste 200 Idaho Falls ID 83402-3320 | |
| (208) 218-8622 | |
| Not Available |
| Full Name | Intermountain Regenerative Medicine |
|---|---|
| Speciality | General Practice |
| Location | 1075 S Utah Ave Ste 200, Idaho Falls, Idaho |
| Authorized Official Name and Position | Marie Barrs (OFFICE MANAGER) |
| Authorized Official Contact | 9194391512 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intermountain Regenerative Medicine 1075 S Utah Ave Ste 200 Idaho Falls ID 83402-3320 Ph: (208) 218-8622 | Intermountain Regenerative Medicine 1075 S Utah Ave Ste 200 Idaho Falls ID 83402-3320 Ph: (208) 218-8622 |
| NPI Number | 1922731827 |
|---|---|
| Provider Enumeration Date | 07/07/2022 |
| Last Update Date | 12/07/2023 |
| Medicare PECOS PAC ID | 0042686636 |
|---|---|
| Medicare Enrollment ID | O20221024000739 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922731827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Jennilee Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386877017 PECOS PAC ID: 4284771437 Enrollment ID: I20160907002693 |
| Provider Name | Amy A Jacobs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316495450 PECOS PAC ID: 0547548158 Enrollment ID: I20230111002042 |
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