Basic Information
| Provider Information | |||||||||
| NPI: | 1972694438 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEDRICK | ||||||||
| FirstName: | FRANCES | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 8TH ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835017301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087461383 | ||||||||
| FaxNumber: | 2087466348 | ||||||||
| Practice Location | |||||||||
| Address1: | 2315 8TH ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835017301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087461383 | ||||||||
| FaxNumber: | 2087466348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 03/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 91-146 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | M7875 | ID | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD00038028 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R8E66 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8246951 | 05 | WA | MEDICAID | 000010005691 | 01 | ID | REGENCE BLUESHIELD | OTHER | 132598 | 01 | WA | WA LABOR & INDUSTRY | OTHER | 34199 | 01 | ID | BLUE CROSS | OTHER | 805544400 | 01 | ID | HEATHLY CONNECTIONS | OTHER | 1142664 | 01 | ID | DMERC | OTHER | 805544400 | 05 | ID | MEDICAID | 841377860 | 01 | ID | MISCELLANEOUS INSURANCE | OTHER |