BLUE LAKES MEDICINE PA NPI 1063872489

NPI Information

NPI: 1063872489
Provider Name: BLUE LAKES MEDICINE PA
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
1122 EASTLAND DR N
STE 2
TWIN FALLS, ID
ZIP 83301
Phone: (208) 734-9531
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BLUE LAKES MEDICINE PA is a family nurse practitioner in Twin Falls, ID. BLUE LAKES MEDICINE PA NPI is 1063872489. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1122 EASTLAND DR N
STE 2
TWIN FALLS, ID
ZIP 83301-444
Phone: (208) 734-9531
Fax: (208) 733-6969

The provider's authorized official is Howard Rusty Arrington .
The authorized official title is Provider / Owner and has the following contact phone number (208) 734-9531.

The enumeration date for this NPI number is 2/26/2016 and was last updated on 2/26/2016.

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	363LF0000X	Nurse Practitioner	Family	NP-1688A	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	1374328	OTHER	IDAHO	MEDICARE PTAN

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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