| Pearl Primary Care Pllc | |
|
2705 E 17th St Ste B Ammon ID 83406-6601 | |
| (208) 497-0566 | |
| (208) 346-7501 |
| Full Name | Pearl Primary Care Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 2705 E 17th St Ste B, Ammon, Idaho |
| Authorized Official Name and Position | Zakery Warren (OWNER/DIRECTOR) |
| Authorized Official Contact | 2083467500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pearl Primary Care Pllc 2705 E 17th St Ste B Ammon ID 83406-6601 Ph: (208) 497-0566 | Pearl Primary Care Pllc 2705 E 17th St Ste B Ammon ID 83406-6601 Ph: (208) 497-0566 |
| NPI Number | 1720561103 |
|---|---|
| Provider Enumeration Date | 09/11/2018 |
| Last Update Date | 09/11/2018 |
| Medicare PECOS PAC ID | 2365796620 |
|---|---|
| Medicare Enrollment ID | O20181126003797 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720561103 | NPI | - | NPPES |
| 1848 | Other | ID | CITY OF AMMON BUSINESS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Stephen Denagy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336273085 PECOS PAC ID: 5294891438 Enrollment ID: I20090312000669 |
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