| White Cloud Wellness | |
|
431 E. Main St. #994 Challis ID 83226 | |
| (208) 833-1313 | |
| (833) 839-1195 |
| Full Name | White Cloud Wellness |
|---|---|
| Speciality | Family Medicine |
| Location | 431 E. Main St., Challis, Idaho |
| Authorized Official Name and Position | Joseph Petrie (OWNER) |
| Authorized Official Contact | 2088331313 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| White Cloud Wellness 431 E. Main St. #994 Challis ID 83226 Ph: (208) 833-1313 | White Cloud Wellness 431 E. Main St. #994 Challis ID 83226 Ph: (208) 833-1313 |
| NPI Number | 1396290953 |
|---|---|
| Provider Enumeration Date | 08/23/2016 |
| Last Update Date | 06/26/2024 |
| Certification Date | 06/26/2024 |
| Medicare PECOS PAC ID | 2163872029 |
|---|---|
| Medicare Enrollment ID | O20231219002482 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396290953 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| Provider Name | Breeann M Petrie |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1235430059 PECOS PAC ID: 6608063524 Enrollment ID: I20101203001251 |
| Provider Name | Joseph W Petrie |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1851721401 PECOS PAC ID: 1355572058 Enrollment ID: I20140321001470 |
Challis Area Health Center Incorporated Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 611 Clinic Rd, Challis, ID 83226 Phone: 208-879-4351 Fax: 208-879-5216 |