Provider Demographics
NPI:1841490075
Name:FULL CIRCLE HEALTH, INC.
Entity type:Organization
Organization Name:FULL CIRCLE HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:D
Authorized Official - Last Name:EPPERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-954-8744
Mailing Address - Street 1:777 N RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9251
Mailing Address - Country:US
Mailing Address - Phone:208-514-2500
Mailing Address - Fax:208-375-2217
Practice Address - Street 1:777 N RAYMOND ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-514-2500
Practice Address - Fax:208-375-2217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1841490075Medicaid
ID807782300Medicaid
ID87843300Medicaid
ID807782300Medicaid
ID131857Medicare Oscar/Certification
ID1841490075Medicaid
ID131843Medicare Oscar/Certification
ID131844Medicare Oscar/Certification
ID131858Medicare Oscar/Certification
ID131839Medicare Oscar/Certification
ID13700301Medicare PIN
ID13700302Medicare PIN
ID131841Medicare Oscar/Certification
ID13700303Medicare PIN
ID13700304Medicare PIN