MEDICARE: COMMUNITY CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1205846425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE PLLC

Provider Business Mailing Address
First Line	:	1995 E 17TH ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6493
Country	:	US
Telephone Number	:	208-529-5252
Fax Number	:	208-529-4434

Provider Business Practice Location Address
First Line	:	1995 E 17TH ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6493
Country	:	US
Telephone Number	:	208-529-5252
Fax Number	:	208-529-4434

Authorized Official
Title or Position	:	DEO
Name	:	RYAN PETERSON
Credential	:
Telephone Number	:	208-525-8448

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1447337068 — STEPHANIE GANSCHOW PHARMD
Practice Location Address:

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

1295738797 — ERIC A WINGERSON D.O.
Practice Location Address:

1995 E 17TH ST , ST. #4
IDAHO FALLS, ID
83404-6493

Practice Phone: 208-524-3939
Practice Fax: 208-524-3950

1063521136 — DR. PETER JEFFREY THOMPSON M.D.
Practice Location Address:

1995 E 17TH ST
IDAHO FALLS, ID
83404-6493

Practice Phone: 208-529-5252
Practice Fax: 208-529-4434

1780766071 — ERIC A. WINGERSON, D.O. & DIGESTIVE HEALTH CENTER, PC
Practice Location Address:

1995 E 17TH ST , SUITE #4
IDAHO FALLS, ID
83404-6493

Practice Phone: 208-524-3939
Practice Fax: 208-524-3950

1902980469 — LAURA J MASON NP
Practice Location Address:

1995 E 17TH ST STE 2
IDAHO FALLS, ID
83404-6493

Practice Phone: 208-529-2352
Practice Fax: 208-528-3332

1598849051 — NORTHSTAR HEALTHCARE LLC
Practice Location Address:

1995 E 17TH ST , STE 2
IDAHO FALLS, ID
83404-6493

Practice Phone: 208-529-2352
Practice Fax: 208-528-3332

Directions to “COMMUNITY CARE PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.