| Magic Valley Family Practice, Pllc | |
|
1182 Eastland Dr N Suite B Twin Falls ID 83301-8972 | |
| (208) 733-5117 | |
| (208) 733-5143 |
| Full Name | Magic Valley Family Practice, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1182 Eastland Dr N, Twin Falls, Idaho |
| Authorized Official Name and Position | Drew B Simmons (NURSE PRACTITIONER/OWNER) |
| Authorized Official Contact | 2087335117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magic Valley Family Practice, Pllc 1182 Eastland Dr N Suite B Twin Falls ID 83301-8972 Ph: (208) 733-5117 | Magic Valley Family Practice, Pllc 1182 Eastland Dr N Suite B Twin Falls ID 83301-8972 Ph: (208) 733-5117 |
| NPI Number | 1528251519 |
|---|---|
| Provider Enumeration Date | 08/22/2007 |
| Last Update Date | 10/15/2007 |
| Medicare PECOS PAC ID | 7911092564 |
|---|---|
| Medicare Enrollment ID | O20070927000751 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528251519 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | NP444A (Idaho) | Primary |
| Provider Name | Drew B Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265428635 PECOS PAC ID: 4385630441 Enrollment ID: I20070927000745 |
| Provider Name | Stacie Ann Benkula |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174116180 PECOS PAC ID: 5193170355 Enrollment ID: I20231009003068 |
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