TABLE ROCK MOBILE MEDICINE PLLC (NPI# 1194186437) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194186437 |
| Entity Type | Organization |
| Organization Name | TABLE ROCK MOBILE MEDICINE PLLC |
| Practice Address |
13960 W Wainwright Dr Boise ID 83713-1969 |
| Mailing Address |
Po Box 44953 Boise ID 83711-0953 |
| Practice Telephone | 2083849022 |
| Practice Fax Number | 2089473465 |
| Mailing Telephone | 2083849022 |
| Mailing Fax Number | 2089473465 |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2016-03-15 |
| Authorized Official Name | BRADLEY BIGFORD (SOLE MEMBER) |
| Authorized Official Telephone | 2083849022 |
| Authorized Official Credential | MSN, NP-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
NP-1252A | ID | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
13960 W WAINWRIGHT DR |
| City | BOISE |
| State | ID |
| Zip Code | 83713-1969 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881676070 | Jamia E. Byrns | Internal Medicine | 13960 W Wainwright Dr, Boise, ID 83713-1969 | 2005-11-15 |
| 1629405857 | Western Pacemaker Clinic, Pllc | Internal Medicine | 13960 W Wainwright Dr, Boise, ID 83713-1969 | 2013-10-02 |
| 1235486960 | Jc Hospitalists Pllc | Hospitalist | 13960 W Wainwright Dr, Boise, ID 83713-1969 | 2012-08-13 |
| 1861703670 | Rachel Marie Thomas | Emergency Medicine | 13960 W Wainwright Dr, Boise, ID 83713-1969 | 2010-06-25 |
| 1013228113 | Aaron L. Holsinger | Emergency Medicine | 13960 W Wainwright Dr, Boise, ID 83713-1969 | 2010-06-24 |
| 1679705586 | Donald Gene Corson | Emergency Medicine | 13960 W Wainwright Dr, Boise, ID 83713-1969 | 2009-08-12 |
| 1396903365 | Justin Charles Hamaker | Emergency Medicine | 13960 W Wainwright Dr, Boise, ID 83713-1969 | 2008-05-27 |
| 1205875275 | Emergency Medicine of Idaho | Emergency Medicine | 13960 W Wainwright Dr, Boise, ID 83713-1969 | 2006-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265902332 | Kidscare Home Health of Idaho, LLC | Home Health | 1835 Wildwood Street, Boise, ID 83713 | 2018-11-30 |
| 1417463928 | Kimberly Ann Bohrer | Behavioral Analyst | 12053 W Hickory Dr, Boise, ID 83713 | 2017-12-19 |
| 1407371891 | Emir Hadzic | Optometrist | 13239 W. Fernleaf St., Boise, ID 83713 | 2017-08-07 |
| 1518336650 | Alliance Physical Medicine | Nurse Practitioner | 13909 W Wainwright Drive, Boise, ID 83713 | 2015-09-18 |
| 1083038335 | Jan L Rehder | Nurse Practitioner | 13150 W Persimmon Lane, Boise, ID 83713 | 2014-02-06 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1659667459 | Jayson Clark | Dentist | 4274 N Eagle Road, Boise, ID 83713 | 2011-06-21 |
| 1043503659 | Steven Anthony Eckhoff | Physician Assistant | 11662 W Arlen St, Boise, ID 83713 | 2011-05-16 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1699930404 | Dennis J. Garpetti, Dds, P.C. | Dentist | 13108 West Persimmon Lane, Boise, ID 83713 | 2008-07-21 |
| Find all providers in zip 83713 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568061398 | Nicolette A Eberline | Nurse Practitioner | 4228 W Guard St Bldg 665, Boise, ID 83705-8049 | 2020-10-22 |
| 1013522275 | Beau Lee | Nurse Practitioner | 2900 N Burton St, Boise, ID 83704-5314 | 2020-09-14 |
| 1588277529 | Tauna Marie Young | Nurse Practitioner | 1681 S Kimball Way, Boise, ID 83709-1654 | 2020-08-28 |
| 1497367114 | Lindsay Ruggles | Nurse Practitioner | 1105 S Federal Way, Boise, ID 83705-2546 | 2020-08-24 |
| 1265056014 | Brynn Crisp | Nurse Practitioner | 1075 N Curtis Rd Ste 100, Boise, ID 83706-1348 | 2020-06-07 |
| 1518592674 | Amber Lynn Gillette | Nurse Practitioner | 1111 S Orchard St Ste 251, Boise, ID 83705-1964 | 2020-03-10 |
| 1265062806 | Jamie Watts | Nurse Practitioner | 5353 W Hill Rd, Boise, ID 83703-2943 | 2020-01-23 |
| 1730654435 | Melissa Gaffrey | Nurse Practitioner | 500 S 8th St, Boise, ID 83702-7107 | 2018-10-09 |
| 1659876399 | Dixie Jean Skinner | Nurse Practitioner | 10583 W. Lake Hazel Rd., Boise, ID 83709-8370 | 2018-03-26 |
| 1063912202 | Devon Moser | Nurse Practitioner | 901 N Curtis Rd Ste 100, Boise, ID 83706-1339 | 2018-02-14 |
| Find all providers in BOISE | ||||
Please comment or provide details below to improve the information on TABLE ROCK MOBILE MEDICINE PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.