| Keystone Center For Geriatrics Llc | |
|
305 W Bannock St Boise ID 83702-6033 | |
| (208) 514-0670 | |
| Not Available |
| Full Name | Keystone Center For Geriatrics Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 305 W Bannock St, Boise, Idaho |
| Authorized Official Name and Position | Leonard Richard Jensen (OWNER) |
| Authorized Official Contact | 2085140670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Keystone Center For Geriatrics Llc 305 W Bannock St Boise ID 83702-6033 Ph: (208) 514-0670 | Keystone Center For Geriatrics Llc 305 W Bannock St Boise ID 83702-6033 Ph: (208) 514-0670 |
| NPI Number | 1376211268 |
|---|---|
| Provider Enumeration Date | 09/03/2021 |
| Last Update Date | 09/03/2021 |
| Medicare PECOS PAC ID | 7618365792 |
|---|---|
| Medicare Enrollment ID | O20211021002038 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376211268 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Susan Melchiore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588605620 PECOS PAC ID: 1355352220 Enrollment ID: I20060508000549 |
| Provider Name | Jamia E Byrns |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881676070 PECOS PAC ID: 8123178225 Enrollment ID: I20090611000305 |
| Provider Name | Leonard R Jensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851604904 PECOS PAC ID: 0042223687 Enrollment ID: I20120820000613 |
| Provider Name | Amy M Dancer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407214497 PECOS PAC ID: 3971800947 Enrollment ID: I20160318001626 |
| Provider Name | Kara M Kuntz |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1891057246 PECOS PAC ID: 0345470282 Enrollment ID: I20160809002853 |
| Provider Name | Kami C Bellomy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952852642 PECOS PAC ID: 9739468471 Enrollment ID: I20161121000109 |
| Provider Name | Mason D Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376188698 PECOS PAC ID: 0941638746 Enrollment ID: I20200310000119 |
| Provider Name | Caitlin E Mohr |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346535952 PECOS PAC ID: 0143440255 Enrollment ID: I20200506003396 |
| Provider Name | Megan A Dunay |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801107974 PECOS PAC ID: 3678710415 Enrollment ID: I20200605000519 |
| Provider Name | Caitlin Elizabeth Kinahan |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1376938076 PECOS PAC ID: 9830400100 Enrollment ID: I20200716001377 |
| Provider Name | James Donald Mcgregor |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1093165912 PECOS PAC ID: 7719270479 Enrollment ID: I20200817003439 |
| Provider Name | Cody J Bonine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528730165 PECOS PAC ID: 5193119238 Enrollment ID: I20220307000254 |
| Provider Name | Reiko J Emtman |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1417390741 PECOS PAC ID: 4880914068 Enrollment ID: I20220525002493 |
| Provider Name | Claudia L Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427071281 PECOS PAC ID: 1355625724 Enrollment ID: I20220825003979 |
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