| Syringa Health And Wellness, Pllc | |
|
1745 Main Ave St Maries ID 83861-1238 | |
| (208) 582-3145 | |
| Not Available |
| Full Name | Syringa Health And Wellness, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1745 Main Ave, St Maries, Idaho |
| Authorized Official Name and Position | Rebekah G Myers (OWNER) |
| Authorized Official Contact | 2085687800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Syringa Health And Wellness, Pllc Po Box 449 St Maries ID 83861-0449 Ph: (208) 582-3145 | Syringa Health And Wellness, Pllc 1745 Main Ave St Maries ID 83861-1238 Ph: (208) 582-3145 |
| NPI Number | 1588309900 |
|---|---|
| Provider Enumeration Date | 04/29/2022 |
| Last Update Date | 10/24/2022 |
| Medicare PECOS PAC ID | 5395124622 |
|---|---|
| Medicare Enrollment ID | O20220616002199 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588309900 | NPI | - | NPPES |
| 1043778624 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Clyde A Hanson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760540801 PECOS PAC ID: 0648356055 Enrollment ID: I20080326000350 |
| Provider Name | Rebekah G Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043778624 PECOS PAC ID: 3072855279 Enrollment ID: I20190508000161 |
| Provider Name | Clyde A Hanson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760540801 PECOS PAC ID: 0648356055 Enrollment ID: I20230202003188 |
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