HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY, PC (NPI# 1255449898) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255449898 |
| Entity Type | Organization |
| Organization Name | HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY, PC |
| Practice Address |
2375 E Sunnyside Rd Ste J Idaho Falls ID 83404-8281 |
| Practice Telephone | 2085254888 |
| Practice Fax Number | 2085254885 |
| Mailing Telephone | 2085254888 |
| Mailing Fax Number | 2085254885 |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | JAMES R WILLIS (PRESIDENT) |
| Authorized Official Telephone | 2085254888 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
M7012 | ID | Allopathic & Osteopathic Physicians |
| Street Address |
2375 E SUNNYSIDE RD STE J |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83404-8281 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649221912 | Matthew R Nelson | Physician Assistant | 2375 E Sunnyside Rd Ste J, Idaho Falls, ID 83404-8281 | 2006-05-12 |
| 1649753740 | Jared William Rickabaugh | Nurse Practitioner | 2375 E Sunnyside Rd Ste J, Idaho Falls, ID 83404-8281 | 2018-09-13 |
| 1992070809 | Pain Specialists of Idaho | Anesthesiology | 2375 E Sunnyside Rd Ste J, Idaho Falls, ID 83404-8281 | 2012-03-12 |
| 1659681534 | Manual Solutions Pllc | Physical Therapist | 2375 E Sunnyside Rd Ste J, Idaho Falls, ID 83404-8281 | 2010-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750809 | Joshua M Murphy | Dentist | 1580 Elk Creek Dr., Idaho Falls, ID 83404 | 2020-11-03 |
| 1427618958 | Eastern Idaho Endodontics | Dentist | 3335 S. Holmes Ave, Idaho Falls, ID 83404 | 2019-06-17 |
| 1942863600 | Muhammad Arslan Khan | Student in an Organized Health Care Education/Training Program | 2860 Channing Way Suite 214, Idaho Falls, ID 83404 | 2019-04-18 |
| 1942771043 | Physician's Choice Cardiology, Pllc | Internal Medicine | 3302 Valencia, Suite 201, Idaho Falls, ID 83404 | 2018-12-16 |
| 1609358761 | Cardiac Cath Lab of Idaho Falls | Internal Medicine | 3311 Valencia Drive, Idaho Falls, ID 83404 | 2018-09-05 |
| 1083196380 | Hannah Golden | Occupational Therapist | 1460 Elk Creek, Idaho Falls, ID 83404 | 2018-09-04 |
| 1316423049 | Lindsay Sessions | Speech-Language Pathologist | 2210 Niagara St, Idaho Falls, ID 83404 | 2018-07-16 |
| 1720574023 | Bmh, Inc. | Anesthesiology | 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 | 2018-07-10 |
| 1093237935 | Jason Earl Bailey | Contractor | 3100 S Woodruff Ave., Idaho Falls, ID 83404 | 2017-07-12 |
| 1235682121 | Mountain Falls Quick Care | Clinic/Center | 1995 E 17th St #1, Idaho Falls, ID 83404 | 2016-07-27 |
| Find all providers in zip 83404 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528279189 | Brandon Lynn Miner | Dermatology | 2085 Providence Way, Idaho Falls, ID 83404-4945 | 2007-05-25 |
| 1063840288 | High Valley Dermatology and Surgery | Dermatology | 2085 Providence Way, Idaho Falls, ID 83404-4945 | 2013-10-25 |
| 1891025334 | High Valley Dermatology & Dermatologic Surgery LLC | Dermatology | 2085 Providence Way, Idaho Falls, ID 83404-4945 | 2010-01-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417456385 | Eagle Dermatology, Pllc | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616-6865 | 2018-02-06 |
| 1568880995 | Ryan Bruce Thorpe | Dermatology | 1618 S Millenium Way Ste 100, Meridian, ID 83642-6457 | 2014-04-02 |
| 1245484096 | Kurtis B Reed | Dermatology | 714 N College Rd, Suite A, Twin Falls, ID 83301-5812 | 2008-11-06 |
| 1295908127 | Idaho Skin Surgery Center, PC | Dermatology | 1906 S Vista Ave, Boise, ID 83705-3453 | 2008-04-11 |
| 1760400238 | Earl Stoddard | Dermatology | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2006-07-17 |
| City | IDAHO FALLS |
| Zip Code | 83404 |
Please comment or provide details below to improve the information on HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY, PC.
| 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.