| Payette Lakes Medical Clinic, Pa | |
|
320 Virginia Avenue New Meadows ID 83654 | |
| (208) 347-2146 | |
| (208) 347-2147 |
| Full Name | Payette Lakes Medical Clinic, Pa |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 320 Virginia Avenue, New Meadows, Idaho |
| Authorized Official Name and Position | Jacqueline R Bruns (VP - PHYSICIAN SERVICES) |
| Authorized Official Contact | 2086344061 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Payette Lakes Medical Clinic, Pa P O Box 1047 Mccall ID 83638-1047 Ph: (208) 347-2146 | Payette Lakes Medical Clinic, Pa 320 Virginia Avenue New Meadows ID 83654 Ph: (208) 347-2146 |
| NPI Number | 1922139468 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 03/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922139468 | NPI | - | NPPES |
| 000010006721 | Other | ID | BS |
| 28340 | Other | ID | BC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |