Individual ProviderPaul Bryan WurtsmithSocial WorkerBehavioral Health & Social Service ProvidersPractice Address3754 Briar Creek Ln, Ammon, ID 83406-4688(360) 831-7425PECOS EnrollmentBased on the most recent information from CMS, provider Paul Bryan Wurtsmith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1154822831Provider TypeIndividualFull NameWurtsmith, Paul BryanGenderMaleSole ProprietorNoEnumeration Date2/27/2018Last Updated2/27/2018Contact InformationPractice LocationPractice Address3754 Briar Creek Ln, Ammon, ID 83406-4688Phone(360) 831-7425FaxUnlisted FaxMailing LocationMailing Address3754 Briar Creek Ln, Ammon, ID 83406-4688Phone(360) 831-7425FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseLMSW-37202Idaho