| Marimn Health | |
|
427 N 12th St Plummer ID 83851 | |
| (208) 686-1931 | |
| Not Available |
| Full Name | Marimn Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 427 N 12th St, Plummer, Idaho |
| Authorized Official Name and Position | Paul Leroy Bergland (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2086865162 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marimn Health Po Box 388 Plummer ID 83851-0388 Ph: (208) 686-1931 | Marimn Health 427 N 12th St Plummer ID 83851 Ph: (208) 686-1931 |
| NPI Number | 1336135136 |
|---|---|
| Provider Enumeration Date | 09/27/2005 |
| Last Update Date | 03/29/2018 |
| Medicare PECOS PAC ID | 6709878622 |
|---|---|
| Medicare Enrollment ID | O20040331001566 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336135136 | NPI | - | NPPES |
| 0026771 | Medicaid | ID | |
| 805801300 | Medicaid | ID | |
| 804166900 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 131814 (Idaho) | Primary |
| Provider Name | Ralph M Sutherlin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1245291772 PECOS PAC ID: 7214099340 Enrollment ID: I20081223000505 |
| Provider Name | Nichole C Vetter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881010833 PECOS PAC ID: 2961621784 Enrollment ID: I20140910000148 |
| Provider Name | Adam K Mills |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1003212069 PECOS PAC ID: 8729302757 Enrollment ID: I20150123000161 |
| Provider Name | Marilou M Gonzalez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1376863712 PECOS PAC ID: 4587982962 Enrollment ID: I20150924001481 |
| Provider Name | Ryan G Kain |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1629166988 PECOS PAC ID: 0042348799 Enrollment ID: I20151117002157 |
| Provider Name | Brian Palmer Meyer |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1710290234 PECOS PAC ID: 9234253857 Enrollment ID: I20160126001269 |
| Provider Name | Willow R Kenyon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982076410 PECOS PAC ID: 7012218365 Enrollment ID: I20180425001167 |
| Provider Name | Katherine Wd Aguirre |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275911356 PECOS PAC ID: 7416250469 Enrollment ID: I20180608002013 |
| Provider Name | Angela Dawn Delio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063869295 PECOS PAC ID: 7810327079 Enrollment ID: I20200501000068 |
| Provider Name | Nikole J Mills |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013192210 PECOS PAC ID: 0244661205 Enrollment ID: I20200507002768 |
| Provider Name | Andrew E Gardner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902268238 PECOS PAC ID: 7012256605 Enrollment ID: I20200513000817 |
| Provider Name | Jason F Chapman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497040349 PECOS PAC ID: 9739329368 Enrollment ID: I20200710002470 |
| Provider Name | Gregory L Dickerson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568887339 PECOS PAC ID: 2062667611 Enrollment ID: I20220505001927 |
| Provider Name | Tonya Marie Amour-patton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225697212 PECOS PAC ID: 7810371770 Enrollment ID: I20220826002218 |
| Provider Name | Aarick Anders Carlson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1396231023 PECOS PAC ID: 1951650092 Enrollment ID: I20221107003035 |
| Provider Name | Chase Albert Francoeur |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1316525900 PECOS PAC ID: 1254704703 Enrollment ID: I20230314001706 |
| Provider Name | Ruth Berner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093752347 PECOS PAC ID: 5890752810 Enrollment ID: I20230726003414 |
| Provider Name | Jamie Dee Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013237189 PECOS PAC ID: 7810330016 Enrollment ID: I20240205002119 |
| Provider Name | Taylor Tweedy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902543226 PECOS PAC ID: 9335582535 Enrollment ID: I20240205002251 |
| Provider Name | David Allen Ingebritsen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538158829 PECOS PAC ID: 1557704459 Enrollment ID: I20240207003729 |