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Michael Brian Lynn

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

100 E Idaho St Ste 316, Boise, ID 83712-6269

PECOS Enrollment

This provider is enrolled in PECOS as MICHAEL LYNN.

Based on the most recent information from CMS, provider Michael Brian Lynn 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
1669774469
Provider Type
Individual
Full Name
Lynn, Michael Brian
Credential
PAC

Gender
Male
Sole Proprietor
No
Enumeration Date
11/30/2010
Last Updated
12/18/2024

Contact Information

Practice Location

100 E Idaho St Ste 316, Boise, ID 83712-6269

(208) 381-9350

(208) 381-9351

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 7361377 Idaho
Code 208600000X	Description Surgery Allopathic & Osteopathic Physicians	License MA054496 Pennsylvania
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License MA054496 Pennsylvania

Provider Identifiers

ID	Description	Issuer
ID 251879554	Description Other	Issuer TAX ID Pennsylvania

Michael Brian Lynn

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Schram, Susan Marie

Bowman, Dustin K

Derkacs, Derek

Nielson, David E

Meziere, Lauren

Nizich, Samantha Marie

Christesen, Celeste Renee

Elkin, Jessica E

Davis, Brittney

Pons, Adriana Elizabeth