IDAHO PATHOLOGY LABORATORY PHYSICIANS (NPI# 1336490119) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336490119 |
| Entity Type | Organization |
| Organization Name | IDAHO PATHOLOGY LABORATORY PHYSICIANS |
| Practice Address |
777 Hospital Way Pocatello ID 83201 |
| Mailing Address |
7069 Running Iron Ln Pocatello ID 83204-3816 |
| Practice Telephone | 2082327666 |
| Practice Fax Number | 2082322334 |
| Mailing Telephone | 2086900364 |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2013-06-12 |
| Authorized Official Name | DR. KRISTOPHER A MCGEE (OWNER OF BUSINESS) |
| Authorized Official Telephone | 2086900364 |
| Authorized Official Credential | M.D., FCAP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 291U00000X | Clinical Medical Laboratory | M11088 | ID | Laboratories |
| Y | 291U00000X | Clinical Medical Laboratory | M11025 | ID | Laboratories |
| Street Address |
777 HOSPITAL WAY |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104825892 | Gregory S Harrison | Neurological Surgery | 777 Hospital Way, Suite 115, Pocatello, ID 83201-5175 | 2005-07-15 |
| 1801401344 | Sunny Blue Alene Nelson | Physician Assistant | 777 Hospital Way, Pocatello, ID 83201-5175 | 2020-09-11 |
| 1316570757 | Mark Alan Pendleton | Nurse Anesthetist, Certified Registered | 777 Hospital Way, Pocatello, ID 83201-5175 | 2020-02-13 |
| 1508413220 | Hilary Worthen | Specialist/Technologist | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-08-19 |
| 1437612447 | Walter S Medlin Md PC | Surgery | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-04-08 |
| 1396203428 | Amber Frost | Family Medicine | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-03-07 |
| 1649756404 | Kamilla Gundersen | Nurse Practitioner | 777 Hospital Way, Pocatello, ID 83207 | 2018-07-16 |
| 1043716285 | Brice Anderson | Specialist/Technologist | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-04-05 |
| 1851808133 | Rocky Mountain Physician Group LLC | Emergency Medicine | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-01-08 |
| 1154838886 | Mark Willis | Nurse Practitioner | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-01-03 |
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| 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 |
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| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831486133 | Laboratory Corporation of America | Clinical Medical Laboratory | 1950 E Clark St Ste E, Pocatello, ID 83201-3314 | 2011-07-07 |
| 1366653800 | Western Pathology Associates LLC | Clinical Medical Laboratory | 1950 E Clark St Ste D, Pocatello, ID 83201-3314 | 2007-05-25 |
| 1295105567 | Idaho State University | Clinical Medical Laboratory | 970 S 5th Ave, Stop 8288, Pocatello, ID 83209-0001 | 2015-09-30 |
| 1619955978 | Laboratory Corporation of America | Clinical Medical Laboratory | 444 Hospital Way, Ste 401, Pocatello, ID 83201-0000 | 2006-01-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770183089 | Boise State University | Clinical Medical Laboratory | Bsu Science Bld Room 239 2133 W Cesar Chavez Ln, Boise, ID 83725-0001 | 2020-10-27 |
| 1730786328 | Idaho One Health Network, LLC | Clinical Medical Laboratory | 4455 S Meridian Rd, Meridian, ID 83642-6917 | 2020-10-06 |
| 1457984981 | Mini-cassia Misdemeanor | Clinical Medical Laboratory | 1359 Hansen Ave, Burley, ID 83318-1821 | 2020-02-12 |
| 1831743228 | Quest Diagnostics Clinical Laboratories Inc | Clinical Medical Laboratory | 215 E Hawaii Ave Ste B-100, Nampa, ID 83686-6011 | 2019-07-24 |
| 1801390521 | Local Lab LLC | Clinical Medical Laboratory | 8382 N Wayne Dr Ste 201, Hayden, ID 83835-6028 | 2018-03-19 |
| 1326553421 | The Local Lab, LLC | Clinical Medical Laboratory | 8382 N Wayne Dr Ste 103, Hayden, ID 83835-6028 | 2017-12-11 |
| 1457722092 | Bear Tooth Laboratory, LLC | Clinical Medical Laboratory | 1125 E Pine Ave, Ste B, Meridian, ID 83642-5955 | 2015-10-08 |
| 1730550377 | Landbank Laboratories, LLC | Clinical Medical Laboratory | 1020 Land Bank St, Suite B, Idaho Falls, ID 83402-1809 | 2015-10-08 |
| 1629486311 | Julia Anne Sanford Biggerstaff | Clinical Medical Laboratory | 4355 W Emerald St, Suite 140, Boise, ID 83706-2050 | 2014-07-26 |
| 1194150003 | Absolute Drug Testing, LLC | Clinical Medical Laboratory | 5433 N Government Way, Suite B, Coeur D Alene, ID 83815-9259 | 2013-09-10 |
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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.