| Reed I. Ward, D.o., P.a. | |
|
3425 Potomac Way Idaho Falls ID 83404-4984 | |
| (208) 528-8170 | |
| (208) 522-5461 |
| Full Name | Reed I. Ward, D.o., P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 3425 Potomac Way, Idaho Falls, Idaho |
| Authorized Official Name and Position | Reed Ivol Ward (OWNER) |
| Authorized Official Contact | 2085288170 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reed I. Ward, D.o., P.a. 3360 Washington Pkwy Ste 2 Idaho Falls ID 83404-8333 Ph: (208) 528-8170 | Reed I. Ward, D.o., P.a. 3425 Potomac Way Idaho Falls ID 83404-4984 Ph: (208) 528-8170 |
| NPI Number | 1306044599 |
|---|---|
| Provider Enumeration Date | 07/10/2007 |
| Last Update Date | 02/24/2020 |
| Medicare PECOS PAC ID | 9931158805 |
|---|---|
| Medicare Enrollment ID | O20120125000968 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306044599 | NPI | - | NPPES |
| 000010138476 | Other | ID | REGENCE BLUE SHIELD OF ID |
| 8N464 | Other | ID | BLUE CROSS OF IDAHO |
| 080184962 | Other | ID | RAILROAD MEDICARE |
| 806385700 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | O-263 (Idaho) | Primary |
| Provider Name | Reed I Ward |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1235217506 PECOS PAC ID: 2769431659 Enrollment ID: I20120125000969 |
| Provider Name | Joshua Trevor Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376069724 PECOS PAC ID: 3870867849 Enrollment ID: I20170914003710 |
| Provider Name | Derek Richard Whitmill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962919662 PECOS PAC ID: 3779845706 Enrollment ID: I20180402002128 |
| Provider Name | Brandee Simpson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528628567 PECOS PAC ID: 1759714355 Enrollment ID: I20200214000926 |
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