| Primary Care Specialists, PA | |
|
110 Vista Drive Pocatello ID 83201 | |
| (208) 234-2300 | |
| (208) 234-0026 |
| Full Name | Primary Care Specialists, PA |
|---|---|
| Speciality | Clinic/Center |
| Location | 110 Vista Drive, Pocatello, Idaho |
| Authorized Official Name and Position | Mark L Mansfield (PRESIDENT) |
| Authorized Official Contact | 2082342300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Specialists, PA 110 Vista Drive Pocatello ID 83201 Ph: (208) 234-2300 | Primary Care Specialists, PA 110 Vista Drive Pocatello ID 83201 Ph: (208) 234-2300 |
| NPI Number | 1508875881 |
|---|---|
| Provider Enumeration Date | 08/05/2006 |
| Last Update Date | 09/18/2012 |
| Medicare PECOS PAC ID | 4082699574 |
|---|---|
| Medicare Enrollment ID | O20210323002420 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508875881 | NPI | - | NPPES |
| 805105400 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Richard M Maynard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952395063 PECOS PAC ID: 1658356167 Enrollment ID: I20040907001278 |
| Provider Name | Mark L Mansfield |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134113251 PECOS PAC ID: 3072531276 Enrollment ID: I20051111000116 |
| Provider Name | Codie M Robertson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134477870 PECOS PAC ID: 7214178318 Enrollment ID: I20130801000652 |
| Provider Name | Adrian J Turpin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1447697735 PECOS PAC ID: 4880813542 Enrollment ID: I20151014001571 |
| Provider Name | Jordan R Stevens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851839542 PECOS PAC ID: 9032493101 Enrollment ID: I20170309001079 |
| Provider Name | Nathan T Rowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114504594 PECOS PAC ID: 3274935671 Enrollment ID: I20210707003555 |
| Provider Name | Brooke L Skinner |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1659038669 PECOS PAC ID: 3072908755 Enrollment ID: I20220315002734 |
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