| Kendrick Clinic | |
|
606 E Main St Kendrick ID 83537 | |
| (208) 289-3841 | |
| (208) 289-3961 |
| Full Name | Kendrick Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 606 E Main St, Kendrick, Idaho |
| Authorized Official Name and Position | Harry Jasper (CFO) |
| Authorized Official Contact | 2088832220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kendrick Clinic 700 S Main St Moscow ID 83843 Ph: (208) 882-4511 | Kendrick Clinic 606 E Main St Kendrick ID 83537 Ph: (208) 289-3841 |
| NPI Number | 1750475380 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 02/14/2017 |
| Medicare PECOS PAC ID | 4981984390 |
|---|---|
| Medicare Enrollment ID | O20170210001663 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750475380 | NPI | - | NPPES |
| 805890000 | Medicaid | ID | |
| 7118532 | Medicaid | WA | |
| 000010138308 | Other | ID | REGENCE |
| 8A612 | Other | ID | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 39 (Idaho) | Primary |
| Provider Name | Gregory P Bauer |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1255496493 PECOS PAC ID: 6901719301 Enrollment ID: I20070831000060 |
| Provider Name | Dustin P Gill |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1558681502 PECOS PAC ID: 4587796222 Enrollment ID: I20190725003692 |