| Mountain West Medical Services Pllc | |
|
1067 S Wells St Suite#110 Meridian ID 83642-7997 | |
| (208) 229-8739 | |
| (208) 895-8540 |
| Full Name | Mountain West Medical Services Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1067 S Wells St, Meridian, Idaho |
| Authorized Official Name and Position | John Kenneth Mcrae (DR. OF NURSE PRACTIONER) |
| Authorized Official Contact | 2082298739 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain West Medical Services Pllc 1067 S Wells St Suite#110 Meridian ID 83642-7997 Ph: (208) 229-8739 | Mountain West Medical Services Pllc 1067 S Wells St Suite#110 Meridian ID 83642-7997 Ph: (208) 229-8739 |
| NPI Number | 1457894339 |
|---|---|
| Provider Enumeration Date | 11/28/2016 |
| Last Update Date | 07/07/2023 |
| Medicare PECOS PAC ID | 2567734668 |
|---|---|
| Medicare Enrollment ID | O20170824001930 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457894339 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 54169 (Idaho) | Primary |
| Provider Name | John Mcrae |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750838504 PECOS PAC ID: 1456623552 Enrollment ID: I20170913003436 |
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