| Moscow Family Medicine Clinic | |
|
623 S Main St Ste 1 Moscow ID 83843-3042 | |
| (208) 882-2011 | |
| (208) 883-1853 |
| Full Name | Moscow Family Medicine Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 623 S Main St Ste 1, Moscow, Idaho |
| Authorized Official Name and Position | Danielle Lynas (CFO) |
| Authorized Official Contact | 2088832220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moscow Family Medicine Clinic 700 S Main St Moscow ID 83843-3046 Ph: (208) 882-4511 | Moscow Family Medicine Clinic 623 S Main St Ste 1 Moscow ID 83843-3042 Ph: (208) 882-2011 |
| NPI Number | 1538634522 |
|---|---|
| Provider Enumeration Date | 10/05/2018 |
| Last Update Date | 10/15/2018 |
| Medicare PECOS PAC ID | 0941545784 |
|---|---|
| Medicare Enrollment ID | O20181221002296 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538634522 | NPI | - | NPPES |
| 39 | Other | ID | STATE OF IDAHO LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Bradley John Capawana |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1447257076 PECOS PAC ID: 7810976388 Enrollment ID: I20050411000883 |
| Provider Name | Dustin K Worth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740307479 PECOS PAC ID: 8123103264 Enrollment ID: I20080930000051 |
| Provider Name | Helen M Shearer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104890177 PECOS PAC ID: 8022195056 Enrollment ID: I20100702000165 |
| Provider Name | Richard Howe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871566679 PECOS PAC ID: 0446221337 Enrollment ID: I20100706000450 |
| Provider Name | Francis K Spain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669445474 PECOS PAC ID: 0840377875 Enrollment ID: I20100708000944 |
| Provider Name | Robert M Ting |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992778708 PECOS PAC ID: 1759468788 Enrollment ID: I20100811001012 |
| Provider Name | Eva L Michels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104134089 PECOS PAC ID: 2466639067 Enrollment ID: I20110913000341 |
| Provider Name | Kyrsten E Stoops |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417261934 PECOS PAC ID: 7810137098 Enrollment ID: I20131219001667 |
| Provider Name | Olisa M Bomley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447691621 PECOS PAC ID: 0941438923 Enrollment ID: I20140121000977 |
| Provider Name | Patricia Nicolle Marciano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053398578 PECOS PAC ID: 3971562471 Enrollment ID: I20140729001281 |
| Provider Name | Ronald F Baldwin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912118928 PECOS PAC ID: 0143219790 Enrollment ID: I20140821001069 |
| Provider Name | Lynley R James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871900225 PECOS PAC ID: 0648491183 Enrollment ID: I20141024002172 |
| Provider Name | Bryn E Parker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598058711 PECOS PAC ID: 1254559883 Enrollment ID: I20150805008069 |
| Provider Name | Summer L Day |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1457627937 PECOS PAC ID: 5496065864 Enrollment ID: I20170804002630 |
| Provider Name | Jessica E Bonnett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669786653 PECOS PAC ID: 0941444160 Enrollment ID: I20190924002800 |
| Provider Name | Meghan Catherine Shutte |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669856118 PECOS PAC ID: 6800198904 Enrollment ID: I20190925003342 |
| Provider Name | Jacques Maurice Bouchard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073871844 PECOS PAC ID: 8224261581 Enrollment ID: I20191002000902 |
| Provider Name | Jacob Kent Christensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407237043 PECOS PAC ID: 4587973268 Enrollment ID: I20191018000276 |
| Provider Name | Lynn Kohlmeier |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1528026820 PECOS PAC ID: 7315959236 Enrollment ID: I20200327002728 |
| Provider Name | Amy Elizabeth Dudley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588028567 PECOS PAC ID: 5092007831 Enrollment ID: I20200914001361 |
| Provider Name | Michelle Dawn Hazen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902414527 PECOS PAC ID: 4486064474 Enrollment ID: I20201103000753 |
| Provider Name | Julia Menard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497027569 PECOS PAC ID: 3173784345 Enrollment ID: I20210127001229 |
| Provider Name | Jennifer L Rouse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710565551 PECOS PAC ID: 7113335415 Enrollment ID: I20210427001540 |
| Provider Name | Jordan Forbush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821680166 PECOS PAC ID: 5496154684 Enrollment ID: I20210519003174 |
| Provider Name | Michael Fields |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841780293 PECOS PAC ID: 3173926979 Enrollment ID: I20210729003706 |
| Provider Name | Camilla Guthrie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487322012 PECOS PAC ID: 7416354576 Enrollment ID: I20210916002014 |
| Provider Name | Robin Ashley Sautter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619402484 PECOS PAC ID: 1951671759 Enrollment ID: I20210924002153 |
| Provider Name | Mark Mitchell Roubidoux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629685235 PECOS PAC ID: 9638577828 Enrollment ID: I20220209002036 |
| Provider Name | Cameron Mackay Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811551583 PECOS PAC ID: 3779960463 Enrollment ID: I20220518002471 |
| Provider Name | Preetha Rosen |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1487886099 PECOS PAC ID: 9638340813 Enrollment ID: I20220907000424 |
| Provider Name | Gwen Elaine Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508989237 PECOS PAC ID: 2466829734 Enrollment ID: I20221031001963 |
| Provider Name | Edward Dubois Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760577308 PECOS PAC ID: 1456359173 Enrollment ID: I20230209000544 |
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