| Winding Creek Medical Arts | |
|
1139 E. Winding Creek Dr Eagle ID 83616 | |
| (208) 938-8887 | |
| (208) 938-8897 |
| Full Name | Winding Creek Medical Arts |
|---|---|
| Speciality | Internal Medicine |
| Location | 1139 E. Winding Creek Dr, Eagle, Idaho |
| Authorized Official Name and Position | Marion Lynn Luque (OWNER) |
| Authorized Official Contact | 2089388887 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Winding Creek Medical Arts 502 E. Two Rivers Dr Eagle ID 83616 Ph: (208) 559-3303 | Winding Creek Medical Arts 1139 E. Winding Creek Dr Eagle ID 83616 Ph: (208) 938-8887 |
| NPI Number | 1275630733 |
|---|---|
| Provider Enumeration Date | 09/19/2006 |
| Last Update Date | 04/07/2014 |
| Medicare PECOS PAC ID | 2062417876 |
|---|---|
| Medicare Enrollment ID | O20060929000461 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275630733 | NPI | - | NPPES |
| 805377200 | Medicaid | ID | |
| M8345 | Other | ID | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | M8345 (Idaho) | Primary |
| Provider Name | Marion L Luque |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124088331 PECOS PAC ID: 5395715726 Enrollment ID: I20040730001101 |
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