IDAHO SKIN SURGERY CENTER, PC (NPI# 1295908127) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295908127 |
| Entity Type | Organization |
| Organization Name | IDAHO SKIN SURGERY CENTER, PC |
| Practice Address |
1906 S Vista Ave Boise ID 83705-3453 |
| Practice Telephone | 2084331114 |
| Practice Fax Number | 2084331115 |
| Mailing Telephone | 2084331114 |
| Mailing Fax Number | 2084331115 |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2014-12-12 |
| Authorized Official Name | JARED SCOTT (PRESIDENT) |
| Authorized Official Telephone | 2084331114 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
M-10116 | ID | Allopathic & Osteopathic Physicians |
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
M-10116 | ID | Allopathic & Osteopathic Physicians |
| Y | 207N00000X | Dermatology | M-10116 | ID | Allopathic & Osteopathic Physicians |
| Street Address |
1906 S VISTA AVE |
| City | BOISE |
| State | ID |
| Zip Code | 83705-3453 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992808893 | Jared M Scott | Dermatology | 1906 S Vista Ave, Boise, ID 83705-3453 | 2006-09-06 |
| 1164851168 | Jessie Marie Zimmerman | Physician Assistant | 1906 S Vista Ave, Boise, ID 83705-3453 | 2013-11-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053938779 | Halo Health Services LLC | Community/Behavioral Health | 1111 S Orchard St, Boise, Id 83705, Boise, ID 83705 | 2020-06-29 |
| 1598265860 | Felica Jo Duce | Counselor | 921 S Orchard St Ste 103, Boise, ID 83705 | 2018-02-13 |
| 1215364278 | Erica Zelickowski | Pharmacist | 1653 S Vista Avenue, Boise, ID 83705 | 2013-10-04 |
| 1952655490 | Aida Dizdar-barac | Social Worker | 2273 S. Vista Avenue, Suite 190, Boise, ID 83705 | 2012-11-06 |
| 1033461033 | Julie Marie Meek | Social Worker | 3324 W Elder St, Boise, ID 83705 | 2012-10-15 |
| 1568761112 | Berkeley Fraser | Pharmacist | 3527 S Federal Way Suite 104, Boise, ID 83705 | 2011-03-22 |
| 1922311042 | Amber Vania | Family Medicine | 4971 W. Overland Road, Boise, ID 83705 | 2010-07-18 |
| 1295056836 | Cherise M Wetzel | Social Worker | 1625 S Eagleson Rd, B1, Boise, ID 83705 | 2010-06-17 |
| 1558685305 | Rae Ann Norell | Social Worker | 2273 S. Vista Ave, #190 Treasure Valley Community Counseling Services, Boise, ID 83705 | 2010-03-23 |
| 1164679932 | Oreana Harless | Social Worker | 2550 South Vista Ave, Boise, ID 83705 | 2008-08-25 |
| Find all providers in zip 83705 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508345091 | Integrated Dermatology of Idaho LLC | Dermatology | 388 E Parkcenter Blvd, Boise, ID 83706-3942 | 2018-08-07 |
| 1104220797 | Boise Skin Clinic Pllc | Dermatology | 1636 S Hadley Ave, Boise, ID 83709-2684 | 2014-10-10 |
| 1487899365 | Jaclyn Golus Mentzer | Dermatology | 388 E. Parkcenter Blvd. Gem State Dermatology, Boise, ID 83706 | 2008-12-08 |
| 1982736435 | Joseph P. Fetzek M.d., P.a. | Dermatology | 10222 Summerwind Dr, Boise, ID 83704-3950 | 2007-03-11 |
| 1154475556 | Joseph Patrick Fetzek | Dermatology | 6111 W Overland Rd, Boise, ID 83709-3018 | 2007-01-22 |
| 1225107386 | Jhon R Hall | Dermatology | 13176 W Persimmon Lane, Boise, ID 83713 | 2006-11-06 |
| 1124106364 | Lindie K Borton | Dermatology | 3811 N Garden Center Way, Boise, ID 83703-5007 | 2006-11-02 |
| 1992808893 | Jared M Scott | Dermatology | 1906 S Vista Ave, Boise, ID 83705-3453 | 2006-09-06 |
| 1104870567 | James H Stewart | Dermatology | 7733 W Emerald St, Boise, ID 83704 | 2006-05-20 |
| 1548214265 | Steven M Mings | Dermatology | 388 E. Parkcenter Blvd., Boise, ID 83706 | 2006-05-19 |
| Find all providers in BOISE | ||||
Please comment or provide details below to improve the information on IDAHO SKIN SURGERY CENTER, 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.