JOHN P BOOTHE (NPI# 1396875720) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1396875720 |
Entity Type | Individual |
Full Name | JOHN P BOOTHE |
Credential | PA-C |
Practice Address |
486 West 1st Ave Glenns Ferry ID 83623 |
Mailing Address |
Po Box 266 Glenns Ferry ID 83623-0266 |
Practice Telephone | 2083667416 |
Practice Fax Number | 2083662595 |
Mailing Telephone | 2083667416 |
Mailing Fax Number | 2083662595 |
Enumeration Date | 2007-03-06 |
Last Update Date | 2007-07-08 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
RPA-101 | ID | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
ID | DEA # | MB0630029 | 01 |
ID | BLUE CROSS OF IDAHO # | PATZ9 | 01 |
ID | BLUESHIELD OF IDAHO GF# | 000010017320 | 01 |
ID | IDAHO MEDICAL LICENSE # | RPA-101 | 01 |
ID | IDAHO CONTROLLED SUBSTA # | CS8825 | 01 |
Street Address |
486 WEST 1ST AVE |
City | GLENNS FERRY |
State | ID |
Zip Code | 83623 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902936362 | Malya Bingham | Counselor | 486 West 1st Ave, Glenns Ferry, ID 83623-0266 | 2007-03-06 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1598263394 | Frances Hammons | Non-emergency Medical Transport (VAN) | 60 East 2nd Ave, Glenns Ferry, ID 83623 | 2018-01-26 |
1205348356 | Tnt Apothecary LLC | Pharmacy | 30 Idaho Ave, Glenns Ferry, ID 83623 | 2017-10-30 |
1629114939 | County of Elmor Consolidated Class A 192 | Local Education Agency (LEA) | 800 Old Hwy 30, Glenns Ferry, ID 83623 | 2007-01-30 |
1851604763 | Glenns Ferry Health Center, Inc. | Counselor | 486 West First Avenue, Glenns Ferry, ID 83623-0266 | 2010-07-20 |
1962654673 | Rachelle Alice Jaramillo | Physician Assistant | 486 W First St, Glenns Ferry, ID 83623-0266 | 2008-10-14 |
1871607523 | Mark Randall Ensminger | Family Medicine | 486 W First Ave, Glenns Ferry, ID 83623-0266 | 2006-08-19 |
1649441627 | John C Welch | General Practice | 486 W 1st Ave, Glenns Ferry, ID 83623-0266 | 2008-03-18 |
1376673137 | Glenns Ferry Health Center, Inc. | Clinic/Center | 486 W 1st Ave, Glenns Ferry, ID 83623-2701 | 2007-03-07 |
1649828229 | Anson Call Dpt Inc | Clinic/Center | 486 W 1st Ave, Glenns Ferry, ID 83623-2701 | 2019-08-28 |
1508339672 | Ridley's Family Markets Inc | Pharmacy | 486 W 1st Ave, Glenns Ferry, ID 83623-2701 | 2019-01-10 |
Find all providers in zip 83623 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962654673 | Rachelle Alice Jaramillo | Physician Assistant | 486 W First St, Glenns Ferry, ID 83623-0266 | 2008-10-14 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1689217911 | David Jeffrey Hanson | Physician Assistant | 740 Mckinley Ave Ste 100, Kellogg, ID 83837-2693 | 2019-10-18 |
1871060681 | Travis Henman | Physician Assistant | 1404 Pomerelle Ave Ste 150, Burley, ID 83318-2012 | 2018-10-30 |
1952889685 | Cody Mattingly | Physician Assistant | 14601 S Pleasant Valley Rd, Kuna, ID 83634-2728 | 2018-08-03 |
1992174072 | Alexa Rhea | Physician Assistant | 2841 Juniper Dr Ste 2, Lewiston, ID 83501-4719 | 2015-09-18 |
1043689441 | Derek R Wynn | Physician Assistant | 607 W Main Street, Grangeville, ID 83530 | 2015-09-16 |
1407223274 | Michael Kenneth Wucinich | Physician Assistant | 775 Pole Line Rd W Ste 302, Twin Falls, ID 83301-5823 | 2015-08-28 |
1811364177 | Ashley Laren Popadics | Physician Assistant | 1510 12th Ave Rd Ste 200, Nampa, ID 83686-6008 | 2015-08-21 |
1073915963 | Jessica Bishop | Physician Assistant | 1499 W Hays St, Boise, ID 83702-5029 | 2014-09-23 |
1447652813 | Jessea Camille Whitlow | Physician Assistant | 2392 Addison Ave E, Twin Falls, ID 83301-6745 | 2014-09-17 |
1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
Find all providers with the same taxonomy |
City | GLENNS FERRY |
Zip Code | 83623 |
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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.