| Salmon River Clinic | |
|
403 Riverfront Dr Salmon ID 83467-5162 | |
| (208) 742-1110 | |
| (208) 742-1120 |
| Full Name | Salmon River Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 403 Riverfront Dr, Salmon, Idaho |
| Authorized Official Name and Position | Darci Neyman (OFFICE MANAGER) |
| Authorized Official Contact | 2084903118 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Salmon River Clinic 403 Riverfront Dr Salmon ID 83467-5162 Ph: (208) 742-1110 | Salmon River Clinic 403 Riverfront Dr Salmon ID 83467-5162 Ph: (208) 742-1110 |
| NPI Number | 1104351972 |
|---|---|
| Provider Enumeration Date | 04/28/2017 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/22/2025 |
| Medicare PECOS PAC ID | 4587941620 |
|---|---|
| Medicare Enrollment ID | O20170427001778 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104351972 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | NP1202A (Idaho) | Primary |
| Provider Name | Myllissa M Wyatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730439266 PECOS PAC ID: 8729230503 Enrollment ID: I20121129000501 |
| Provider Name | Jennie L Brumfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811369689 PECOS PAC ID: 7214238963 Enrollment ID: I20151222001567 |
| Provider Name | John D Pena |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730787482 PECOS PAC ID: 6103238670 Enrollment ID: I20201208001184 |
| Provider Name | Monica Lena White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548772338 PECOS PAC ID: 0749699940 Enrollment ID: I20210429000853 |
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