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Mariah Emily Mcreynolds

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

This provider is enrolled in PECOS as MARIAH MCREYNOLDS.

Based on the most recent information from CMS, provider Mariah Emily Mcreynolds is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 9:43 AM.

Profile Details

Provider ID
1528570991
Provider Type
Individual
Full Name
Mcreynolds, Mariah Emily
Gender
Female

Sole Proprietor
No
Enumeration Date
10/25/2017
Last Updated
10/5/2023

Contact Information

Practice Location

190 E Bannock St, Boise, ID 83712-6241

(208) 381-5015

Unlisted Fax

Mailing Location

190 E Bannock St, Boise, ID 83712-6241

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA-2511 Idaho
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA55182 California

Mariah Emily Mcreynolds

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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Stirling, Brandon

Talford, David B

Riggs, Rodney

Manko, Marc

Schram, Susan Marie

Thomas, Clayton Andrew

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Smith, Samantha Jo

Giles, Thomas Ryan