| Primary Health Medical Group | |
|
11197 W Fairview Ave Boise ID 83713-7935 | |
| (208) 378-8011 | |
| (208) 322-8095 |
| Full Name | Primary Health Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 11197 W Fairview Ave, Boise, Idaho |
| Authorized Official Name and Position | David Peterman (PRESIDENT) |
| Authorized Official Contact | 2089556522 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Health Medical Group Po Box 191050 Boise ID 83719-1050 Ph: (208) 955-6500 | Primary Health Medical Group 11197 W Fairview Ave Boise ID 83713-7935 Ph: (208) 378-8011 |
| NPI Number | 1316183601 |
|---|---|
| Provider Enumeration Date | 12/17/2008 |
| Last Update Date | 12/20/2011 |
| Medicare PECOS PAC ID | 3971544685 |
|---|---|
| Medicare Enrollment ID | O20111018000146 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316183601 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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