SHANA L TUBACH MD NPI 1205879483

NPI Information

  • NPI: 1205879483
  • Provider Name: SHANA L TUBACH, MD
  • Classification: Pediatrics - 208000000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1072 N LIBERTY ST
    SUITE 203
    BOISE, ID
    ZIP 83704
  • Phone: (208) 302-5800

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NPI Details

Shana L Tubach, MD is a pediatrics in Boise, ID. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. Shana L Tubach, MD NPI is 1205879483. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1072 N LIBERTY ST
SUITE 203
BOISE, ID
ZIP 83704-708
Phone: (208) 302-5800
Fax: (208) 302-5855

The NPI 1205879483 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/14/2006 and was last updated on 11/10/2016.

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
1208000000XPediatricsM8077IDAHONo
2208000000XPediatricsM-8077IDAHOYes

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
111443371MEDICARE PINIDAHO
2805784500MEDICAIDIDAHO

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: 3/30/2025

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