MEDICARE: CEDAR MOUNTAIN MEDICAL INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0144814	OTHER	WA	WA DEPT OF LABOR
3	000010014605	OTHER	ID	BLUE SHIELD OF ID
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	03566	OTHER	ID	BLUE CROSS OF IDAHO, GA,

General Provider Information

NPI Number	:	1295748457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR MOUNTAIN MEDICAL INC.

Provider Business Mailing Address
First Line	:	PO BOX 3250
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83877-3250
Country	:	US
Telephone Number	:	208-777-9199
Fax Number	:	208-777-8580

Provider Business Practice Location Address
First Line	:	503 E SELTICE WAY STE 8
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-6499
Country	:	US
Telephone Number	:	208-777-9199
Fax Number	:	208-777-8580

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. THOMAS PAUL JOHNSON
Credential	:
Telephone Number	:	208-777-9199

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	09/16/2008

Similar Medicare Providers

1720502677 — MR. RAFAEL DAVID PENA PTA
Practice Location Address:

2871 POST RD , PREHAB SPORTS MEDICARE SERVICES INC.
WARWICK, RI
02886-0076

Practice Phone: 401-463-3060
Practice Fax: 401-732-1045

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:

1184280414 — ELIZABETH (LIBBY) ANN TUCKER LCPC
Practice Location Address:

949 E 4TH AVE
POST FALLS, ID
83854-4096

Practice Phone: 208-723-9474
Practice Fax:

1144653247 — KATY L WARZECHA CNM
Practice Location Address:

1300 E MULLAN AVE STE 500
POST FALLS, ID
83854-6058

Practice Phone: 208-625-5635
Practice Fax: 208-625-5636

1609298165 — MRS. JESSICA CROCKETT LMFT
Practice Location Address:

1224 N IDAHO ST STE 7
POST FALLS, ID
83854-9024

Practice Phone: 509-944-5467
Practice Fax:

1659187383 — TAMARACK PHARMACY LLC
Practice Location Address:

805 E POLSTON AVE
POST FALLS, ID
83854-6044

Practice Phone: 208-457-4112
Practice Fax: 208-457-4122

Directions to “CEDAR MOUNTAIN MEDICAL INC. ” 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 © 2007-2025 (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.