SOUTHEAST IDAHO GASTROENTEROLOGY PLLC NPI 1780867457

NPI Information

NPI: 1780867457
Provider Name: SOUTHEAST IDAHO GASTROENTEROLOGY, PLLC
Classification: Physician Assistant - 363AM0700X
Entity Type: Organization

Specialization: Medical

Address:
1151 HOSPITAL WAY STE A
POCATELLO, ID
ZIP 83201
Phone: (208) 232-6616
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SOUTHEAST IDAHO GASTROENTEROLOGY, PLLC is a medical physician assistant in Pocatello, ID. SOUTHEAST IDAHO GASTROENTEROLOGY, PLLC NPI is 1780867457. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1151 HOSPITAL WAY STE A
POCATELLO, ID
ZIP 83201-091
Phone: (208) 232-6616
Fax: (208) 232-6618

The provider's authorized official is Debbie J Ferrel .
The authorized official title is Practice Manager and has the following contact phone number (208) 232-6616.

The enumeration date for this NPI number is 12/17/2007 and was last updated on 12/17/2007.

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	PA-629	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	806196200	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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