Rencher Family Practice, PA
Clinic/Center, Primary Care in Idaho Falls, ID. Organization (NPI-2).
NPI number1902048879
StatusActive
Last updated in NPPESMar 24, 2009
Details
- NPI
- 1902048879
- Entity type
- Organization (NPI-2)
- Legal business name
- Rencher Family Practice, PA
- Organization subpart
- No
- Enumeration date
- Mar 24, 2009
- Last updated
- Mar 24, 2009
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | M4486 | ID | Yes |
Practice location
2610 Channing WayIdaho Falls, ID 83404-7517
Phone 208-523-0888
Mailing address
2610 Channing WayIdaho Falls, ID 83404
Phone 208-523-0888
Authorized official
Mark B Rencher
Physician
2085230888
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