| Primary Peak Llc | |
|
1003 N Orchard St Boise ID 83706-2231 | |
| (208) 331-6700 | |
| (208) 331-6707 |
| Full Name | Primary Peak Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1003 N Orchard St, Boise, Idaho |
| Authorized Official Name and Position | Jennie Coleman (OWNER) |
| Authorized Official Contact | 2088211188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Peak Llc 523 Sherry Ln Nampa ID 83686-8874 Ph: (208) 821-1188 | Primary Peak Llc 1003 N Orchard St Boise ID 83706-2231 Ph: (208) 331-6700 |
| NPI Number | 1811750458 |
|---|---|
| Provider Enumeration Date | 02/05/2024 |
| Last Update Date | 05/13/2025 |
| Medicare PECOS PAC ID | 1052853264 |
|---|---|
| Medicare Enrollment ID | O20240603004162 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811750458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Susan J Sansom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538611397 PECOS PAC ID: 8123300191 Enrollment ID: I20170126002639 |
| Provider Name | Guniz Bas Uzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033971783 PECOS PAC ID: 4880034792 Enrollment ID: I20240425001960 |
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