WALLACE BAKERS MID-LEVEL GROUP NPI 1639370810

NPI Information

NPI: 1639370810
Provider Name: WALLACE BAKERS MID-LEVEL GROUP
Classification: Physician Assistant - 363AM0700X
Entity Type: Organization

Specialization: Medical

Address:
1880 JOHN ADAMS PKWY
IDAHO FALLS, ID
ZIP 83401
Phone: (208) 524-6633
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WALLACE BAKERS MID-LEVEL GROUP is a medical physician assistant in Idaho Falls, ID. WALLACE BAKERS MID-LEVEL GROUP NPI is 1639370810. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1880 JOHN ADAMS PKWY
IDAHO FALLS, ID
ZIP 83401-315
Phone: (208) 524-6633
Fax: (208) 524-9952

The provider's authorized official is Wallace Coleman Baker .
The authorized official title is Ceo and has the following contact phone number (208) 524-6633.

The enumeration date for this NPI number is 5/29/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	M6919	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	8076593	MEDICAID	IDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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