| Upper Valley Family Medicine Pllc | |
|
711 Rigby Lake Dr Ste 115 Rigby ID 83442-5230 | |
| (208) 745-5021 | |
| (208) 745-5026 |
| Full Name | Upper Valley Family Medicine Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 711 Rigby Lake Dr Ste 115, Rigby, Idaho |
| Authorized Official Name and Position | Darin T Berrett (OFFICE MANAGER) |
| Authorized Official Contact | 2087455021 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Upper Valley Family Medicine Pllc 711 Rigby Lake Dr Ste 115 Rigby ID 83442-5230 Ph: (208) 745-5021 | Upper Valley Family Medicine Pllc 711 Rigby Lake Dr Ste 115 Rigby ID 83442-5230 Ph: (208) 745-5021 |
| NPI Number | 1073697884 |
|---|---|
| Provider Enumeration Date | 10/25/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 9133195548 |
|---|---|
| Medicare Enrollment ID | O20040908000127 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073697884 | NPI | - | NPPES |
| 8067451700 | Medicaid | ID | |
| 806913600 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | William D Adams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467403733 PECOS PAC ID: 6507855418 Enrollment ID: I20040506001660 |
| Provider Name | Richard T Harper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477599538 PECOS PAC ID: 4981503760 Enrollment ID: I20041220000405 |
| Provider Name | Tiffany J Spaulding |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679704753 PECOS PAC ID: 3274718036 Enrollment ID: I20110921000209 |
| Provider Name | Spencer G Stanger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780194696 PECOS PAC ID: 4486913274 Enrollment ID: I20180124002909 |
| Provider Name | Justin Shippen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871941724 PECOS PAC ID: 5698068427 Enrollment ID: I20190924000013 |
| Provider Name | Analee S Fish |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407405111 PECOS PAC ID: 0143657841 Enrollment ID: I20200302001391 |
Upper Valley Family Medicine Rhc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 530 Rigby Lake Dr, Rigby, ID 83442 Phone: 208-745-5021 Fax: 208-745-5026 | |
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