Family and Adolescent Care of Twin Falls PA
Organization Active NPI Family Nurse Practitioner · Twin Falls, ID
NPI 1477816809 · NPPES record last updated Aug 26, 2013
Key facts
- NPI
- 1477816809
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- NP-986A (ID)
- Legal business name
- FAMILY AND ADOLESCENT CARE OF TWIN FALLS PA
- Practice address
- 476 Cheney Drive West
Suite 160
Twin Falls, ID 83301 - Phone
- (208) 944-0497
- Fax
- (208) 944-0506
- NPI assigned
- Jun 20, 2012
- Organization subpart
- No
Authorized official
- Name
- Roanne Mancari, NP-C
- Title
- Owner
- Phone
- (208) 731-6971
Practitioners 7
-
Roanne Mancari, FNP-C
-
Stephanie Ann York, FNP
-
Stacie McComas, NP-C
-
Erica Cameron, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120802000512 | ID | Part B Supplier - Clinic/Group Practice | 1759537038 |
Receives reassigned benefits from 7 practitioners Practice locations: Twin Falls, ID |
National Provider Directory
Locations
1385 Park View Dr
Ste 101
Twin Falls, ID 83301
Phone (208) 944-0497
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | NP-986A | ID | Yes |
Addresses
Primary practice location
476 Cheney Drive West
Suite 160
Twin Falls, ID 83301
Mailing address
476 Cheney Drive West
Suite 160
Twin Falls, ID 83301
Phone (208) 944-0497
Other providers in Twin Falls, ID
- Kimberly Ann Failes
- Laura M Fall
- Falls Avenue Immediate Care PA
- Falls Centre for Functional Medicine, PLLC.
- Falls Orthodontics PLLC
- Family Footsteps, Inc.
- Family Health Services Corporation
- Family Health Services Corporation
- Family Health Services Corporation
- Family Health Services Corporation
All providers in Twin Falls, ID · Family Nurse Practitioner in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.