MATTHEW J FACKRELL (NPI# 1215968045) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215968045 |
| Entity Type | Individual |
| Full Name | MATTHEW J FACKRELL |
| Credential | DO |
| Practice Address |
1441 Parkway Dr Blackfoot ID 83221-1667 |
| Practice Telephone | 2087852600 |
| Practice Fax Number | 2087858185 |
| Mailing Telephone | 2087852600 |
| Mailing Fax Number | 2087858185 |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2008-03-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 02002954A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | PTAN | 1374716 | 01 |
| Street Address |
1441 PARKWAY DR |
| City | BLACKFOOT |
| State | ID |
| Zip Code | 83221-1667 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447253968 | Francis T Johansen | Internal Medicine | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2005-05-30 |
| 1467942144 | Nicole Bair | Physical Therapist | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2018-05-17 |
| 1467816579 | Mvh Bmc LLC | Family Medicine | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2016-04-06 |
| 1720448590 | Max Barney | Nurse Practitioner | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2016-03-07 |
| 1649699174 | Mvh Bmc LLC | Surgery | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2014-04-14 |
| 1477984524 | Shantel Steffler | Nurse Practitioner | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2013-11-27 |
| 1902149180 | R & J Pharmacy, Inc | Pharmacy | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2013-04-05 |
| 1740580794 | Blackfoot Medical Clinic Surgeons | Surgery | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2010-10-25 |
| 1356665087 | George G Hales | Family Medicine | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2010-03-24 |
| 1649401407 | Jared L Mckee | Physical Therapist | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2009-07-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932711165 | Samantha Paige Averett | Social Worker | 60 N Broadway, Blackfoot, ID 83221 | 2020-08-19 |
| 1730711656 | Sara Marie Letham | Family Medicine | 33 S Thompson Lane, Blackfoot, ID 83221 | 2020-02-08 |
| 1962994962 | Tyler Thomas Wood | Student in an Organized Health Care Education/Training Program | 98 Poplar Street, Blackfoot, Id 83221, Blackfoot, ID 83221 | 2018-06-05 |
| 1801336276 | Bmh, Inc. | Internal Medicine | 235 Poplar St, Blackfoot, ID 83221 | 2017-03-03 |
| 1497119804 | Susan Doran | Social Worker | 720 E. Alice, Blackfoot, ID 83221 | 2016-04-12 |
| 1427412121 | Josie Russell Adkins | Counselor | 720 East Alice, Blackfoot, ID 83221 | 2016-04-08 |
| 1740590314 | Ashley Nichole Thomas | Physician Assistant | 710 E. Alice Street, Blackfoot, ID 83221 | 2010-10-18 |
| 1528373313 | Stephanie Lynn Henderson | Dietitian, Registered | 1555 Vernon Ave, Blackfoot, ID 83221 | 2010-08-17 |
| 1184850141 | Joy H. Taylor | Nurse Practitioner | 1441 Parkway Drive, Blackfoot, ID 83221 | 2009-06-04 |
| 1427232925 | Nathan E. Sneddon | Anesthesiology | 98 Poplar St Fl 3, Blackfoot, ID 83221 | 2007-12-20 |
| Find all providers in zip 83221 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730711656 | Sara Marie Letham | Family Medicine | 33 S Thompson Lane, Blackfoot, ID 83221 | 2020-02-08 |
| 1356416861 | Community Council of Idaho, Inc. | Family Medicine | 625 W Pacific St, Suite 3, Blackfoot, ID 83221-2034 | 2006-11-21 |
| 1477627982 | Jace A Bird | Family Medicine | 145 W Idaho St, Blackfoot, ID 83221-2255 | 2006-11-17 |
| 1487767174 | Richard Cutler Hill | Family Medicine | 120 N 900 W, Blackfoot, ID 83221-5343 | 2006-08-16 |
| 1164440814 | Amador Ramirez Cantu | Family Medicine | 354 S 1000 W, Blackfoot, ID 83221-6085 | 2006-07-18 |
| 1053379461 | Peggy Toro | Family Medicine | 315 W Idaho St, Blackfoot, ID 83221-1711 | 2006-05-03 |
| 1467816579 | Mvh Bmc LLC | Family Medicine | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2016-04-06 |
| 1356665087 | George G Hales | Family Medicine | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2010-03-24 |
| 1124283254 | Blackfoot Medical Clinic Rhc | Family Medicine | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2008-07-29 |
| 1487851424 | Bmh, Inc. | Family Medicine | 315 W Idaho St, Blackfoot, ID 83221-1711 | 2007-07-02 |
| Find all providers in BLACKFOOT | ||||
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| 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.