Provider Demographics
NPI:1588309900
Name:SYRINGA HEALTH AND WELLNESS, PLLC
Entity type:Organization
Organization Name:SYRINGA HEALTH AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:208-568-7800
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-0449
Mailing Address - Country:US
Mailing Address - Phone:208-582-3145
Mailing Address - Fax:
Practice Address - Street 1:1745 MAIN AVE
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1238
Practice Address - Country:US
Practice Address - Phone:208-582-3145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-29
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1043778624Medicaid