SOUTHEAST IDAHO GASTROENTEROLOGY,PLLC (NPI# 1295754265) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295754265 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST IDAHO GASTROENTEROLOGY,PLLC |
| Practice Address |
1151 Hospital Way Bldg A Pocatello ID 83201-2763 |
| Mailing Address |
Po Box 4788 Pocatello ID 83205-4788 |
| Practice Telephone | 2082326616 |
| Practice Fax Number | 2082326618 |
| Mailing Telephone | 2082326616 |
| Mailing Fax Number | 2082326618 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2012-09-25 |
| Authorized Official Name | DARRYL BRUCE COOK (MEMBER) |
| Authorized Official Telephone | 2082326616 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 002803000 | 05 |
| Street Address |
1151 HOSPITAL WAY BLDG A |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-2763 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073022778 | Kimberly Dolecheck Tverdy | Physician Assistant | 1151 Hospital Way Bldg A, Pocatello, ID 83201-5091 | 2017-09-25 |
| 1871016071 | Portneuf Asc, LLC | Clinic/Center | 1151 Hospital Way Bldg A, Pocatello, ID 83201-5091 | 2017-07-19 |
| 1710358007 | Matthew Gregson | Physician Assistant | 1151 Hospital Way Bldg A, Pocatello, ID 83201-5091 | 2015-10-12 |
| 1114028354 | Shad Carl Johnson | Physician Assistant | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-09-26 |
| 1972525111 | Darryl Bruce Cook | Internal Medicine | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-07-24 |
| 1295757433 | Thomas Vance Davis | Internal Medicine | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-07-24 |
| 1992727143 | Charles Barclay Evans | Internal Medicine | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-07-24 |
| 1770502767 | Endoscopy Center, LLC | Clinic/Center | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649474719 | Jonathan D Godfrey | Internal Medicine | 1151 Hospital Way, Building A, Pocatello, ID 83201-5091 | 2007-06-13 |
| 1972525111 | Darryl Bruce Cook | Internal Medicine | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-07-24 |
| 1295757433 | Thomas Vance Davis | Internal Medicine | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-07-24 |
| 1992727143 | Charles Barclay Evans | Internal Medicine | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649516212 | Theodore Weldon Bohlman | Internal Medicine | 8820 Stewart Rd, Meridian, ID 83642-7226 | 2012-12-29 |
| 1679890057 | Walter W Hair | Internal Medicine | 1402 N Promontory Rd, Boise, ID 83702-3040 | 2010-04-26 |
| 1659492809 | Bruce R Croffy | Internal Medicine | 3000 E Pine Ave, Meridian, ID 83642-5995 | 2007-04-03 |
| 1598843039 | Judith Erika Csanky | Internal Medicine | 1411 Falls Ave E Ste 1151, Twin Falls, ID 83301-3455 | 2006-11-01 |
| 1235211582 | George Christopher Kutteruf | Internal Medicine | 1607 Lincoln Way, Suite 200, Coeur D Alene, ID 83814-2476 | 2006-10-19 |
| 1164515276 | Healing Arts Day Surgery LLC | Internal Medicine | 222 W Iowa Ave Ste B, Suite B, Nampa, ID 83686-6814 | 2006-10-02 |
| 1194817023 | Treasure Valley Gastroenterology Specialists Inc | Internal Medicine | 222 W Iowa Ave, Suite A, Nampa, ID 83686-6813 | 2006-09-28 |
| 1740386432 | John Carl Morgenstern | Internal Medicine | 1630 23rd Ave Ste 701, Lewiston, ID 83501-6345 | 2006-09-16 |
| 1164525853 | Raquel Croitoru | Internal Medicine | 222 W Iowa Ave Ste A, Nampa, ID 83686-6814 | 2006-09-07 |
| 1184619165 | Paul H Baehr | Internal Medicine | 425 W Bannock St, Boise, ID 83702-6035 | 2005-09-15 |
| Find all providers with the same taxonomy | ||||
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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.