| Main Street Medical Llc | |
|
6641 Kaniksu St Suite A Bonners Ferry ID 83805-7532 | |
| (208) 265-3655 | |
| (208) 267-3757 |
| Full Name | Main Street Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 6641 Kaniksu St, Bonners Ferry, Idaho |
| Authorized Official Name and Position | Chuck Newhouse (OWNER) |
| Authorized Official Contact | 2082653655 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Medical Llc Po Box 1640 Bonners Ferry ID 83805-1640 Ph: (208) 265-3655 | Main Street Medical Llc 6641 Kaniksu St Suite A Bonners Ferry ID 83805-7532 Ph: (208) 265-3655 |
| NPI Number | 1134274103 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 02/22/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134274103 | NPI | - | NPPES |
| M7989 | Other | ID | IDAHO LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M-7989 (Idaho) | Primary |
Kaniksu Community Health Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6615 Comanche St, Bonners Ferry, ID 83805 Phone: 208-267-1718 Fax: 208-267-7739 | |
Cornerstone Urgent Care & Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 32 David Thompson Dr Ste A, Bonners Ferry, ID 83805 Phone: 208-267-3934 | |
Diehl Internal Medicine Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6640 Kaniksu St, Bonners Ferry, ID 83805 Phone: 540-454-1848 | |
Kootenai Tribal Health Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 100 Circle Drive, Bonners Ferry, ID 83805 Phone: 208-267-5223 Fax: 208-267-8419 | |
Kaniksu Health Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6635 Comanche St, Bonners Ferry, ID 83805 Phone: 208-267-1718 Fax: 208-267-7739 | |
Boundary Community Clinics Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6641 Kaniksu St, Bonners Ferry, ID 83805 Phone: 208-267-3655 Fax: 208-267-3757 |