| Ketchum Family Medicine, Pllc | |
|
431 Walnut Ave N Ketchum ID 83340 | |
| (208) 622-3180 | |
| Not Available |
| Full Name | Ketchum Family Medicine, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 431 Walnut Ave N, Ketchum, Idaho |
| Authorized Official Name and Position | Ashley Brown (OWNER) |
| Authorized Official Contact | 2087210676 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ketchum Family Medicine, Pllc Po Box 6471 Ketchum ID 83340-6471 Ph: (208) 622-3180 | Ketchum Family Medicine, Pllc 431 Walnut Ave N Ketchum ID 83340 Ph: (208) 622-3180 |
| NPI Number | 1720692650 |
|---|---|
| Provider Enumeration Date | 09/08/2020 |
| Last Update Date | 11/12/2020 |
| Medicare PECOS PAC ID | 7113347717 |
|---|---|
| Medicare Enrollment ID | O20201021000353 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720692650 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mary B Curtis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205870417 PECOS PAC ID: 6800989138 Enrollment ID: I20070904000008 |
| Provider Name | Bruce E. Gollub |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508855917 PECOS PAC ID: 0941464986 Enrollment ID: I20231019002085 |
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