IDAHO DIABETES AND ENDOCRINE ASSOCIATES PA NPI 1790960961

NPI Information

NPI: 1790960961
Provider Name: IDAHO DIABETES AND ENDOCRINE ASSOCIATES, PA

Doing Business As: IDAHO DIABETES & ENDOCRINE ASSOCIATES, PA

Classification: Internal Medicine - 207RE0101X
Entity Type: Organization

Specialization: Endocrinology, Diabetes & Metabolism

Address:
13909 W. WAINWRIGHT DRIVE
BOISE, ID
ZIP 83713
Phone: (208) 389-2213
Get Directions

IDAHO DIABETES AND ENDOCRINE ASSOCIATES, PA is an endocrinology and diabetes and metabolism internal medicine in Boise, ID. The provider is an internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. IDAHO DIABETES AND ENDOCRINE ASSOCIATES, PA NPI is 1790960961. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Idaho Diabetes & Endocrine Associates, Pa.

The provider's business location address is:

13909 W. WAINWRIGHT DRIVE
BOISE, ID
ZIP 83713-969
Phone: (208) 389-2213
Fax: (208) 389-4659

The provider's authorized official is Theodore S Roosevelt .
The authorized official title is President and has the following contact phone number (208) 389-2213.

The CLIA number assigned to this NPI record is 13D0998977 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/7/2008 and was last updated on 5/18/2022.

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	174400000X	Specialist				No
2	207RE0101X	Internal Medicine	Endocrinology, Diabetes & Metabolism			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	77021	OTHER	IDAHO	BLUE CROSS OF IDAHO
2	000010035381	OTHER	IDAHO	REGENCE BLUE SHIELD OF ID
3	002712100	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: 4/28/2024

NPI Synchronization or Removal

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