| Vista Healthcare Pc | |
|
556 Trejo St Ste B Rexburg ID 83440-2626 | |
| (208) 351-6981 | |
| Not Available |
| Full Name | Vista Healthcare Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 556 Trejo St Ste B, Rexburg, Idaho |
| Authorized Official Name and Position | Rachelle Jones (PRESIDENT) |
| Authorized Official Contact | 2088810902 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vista Healthcare Pc 556 Trejo Street Suite B Rexburg ID 83440-2625 Ph: (208) 351-6981 | Vista Healthcare Pc 556 Trejo St Ste B Rexburg ID 83440-2626 Ph: (208) 351-6981 |
| NPI Number | 1720502370 |
|---|---|
| Provider Enumeration Date | 07/26/2017 |
| Last Update Date | 11/17/2017 |
| Medicare PECOS PAC ID | 4587921788 |
|---|---|
| Medicare Enrollment ID | O20171127000338 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720502370 | NPI | - | NPPES |
| 1982830345 | Medicaid | ID |
| Provider Name | Amber D Masse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235208687 PECOS PAC ID: 0345141115 Enrollment ID: I20040115000331 |
| Provider Name | Rachelle Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982830345 PECOS PAC ID: 5193877470 Enrollment ID: I20090716000782 |
| Provider Name | Rebecca M Jeppson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033351895 PECOS PAC ID: 0042356644 Enrollment ID: I20091013000426 |
| Provider Name | Marquee G Ricks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902429392 PECOS PAC ID: 2769804459 Enrollment ID: I20200625002507 |
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