STATE OF IDAHO (NPI# 1588780449) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588780449 |
| Entity Type | Organization |
| Organization Name | STATE OF IDAHO |
| Other Organization Name | DHW ISSH GROUP PHYSICIANS |
| Practice Address |
1660 11th Ave N Nampa ID 83687-5000 |
| Practice Telephone | 2084422812 |
| Practice Fax Number | 2084675978 |
| Mailing Telephone | 2084422812 |
| Mailing Fax Number | 2084675978 |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | SUE BROETJE (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Telephone | 2084422812 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers |
| Other Name | Type Code |
|---|---|
| DHW ISSH GROUP PHYSICIANS | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962755868 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1182 West Kyler Ave, Hayden, ID 83835 | 2012-10-17 |
| 1316063787 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-21 |
| 1750442315 | State of Idaho | Pharmacy | 700 East Alice Street, Blackfoot, ID 83221 | 2006-12-13 |
| 1801833454 | State of Idaho | Optometrist | 120 S Cole Rd, Suite 120 - Bldg 3, Boise, ID 83709-0932 | 2006-06-01 |
| 1649277393 | State of Idaho | Home Health | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2005-07-07 |
| 1790131027 | State of Idaho | Community/Behavioral Health | 1720 N Westgate Dr, Boise, ID 83704-7164 | 2016-05-05 |
| 1053615260 | State of Idaho | Psychologist | 700 E Alice St, Blackfoot, ID 83221-4925 | 2011-01-03 |
| 1538285481 | State of Idaho | Optometrist | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| 1265558019 | State of Idaho | Family Medicine | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| 1235260829 | State of Idaho | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2007-03-08 |
| Street Address |
1660 11TH AVE N |
| City | NAMPA |
| State | ID |
| Zip Code | 83687-5000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316063787 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-21 |
| 1265559314 | State of Idaho-dba Idaho State School & Hospital Pharmacy | Pharmacy | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-23 |
| 1538285481 | State of Idaho | Optometrist | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| 1265558019 | State of Idaho | Family Medicine | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699307447 | Current Physical Therapy Nampa LLC | Physical Therapist | 16150 N High Desert Street, Nampa, ID 83687 | 2020-02-10 |
| 1356867683 | Nampa of Cascadia, LLC | Skilled Nursing Facility | 900 North Happy Valley Rd, Nampa, ID 83687 | 2017-08-18 |
| 1750828513 | Daniel & Max, LLC | Optometrist | 1600 Karcher Rd, Nampa, ID 83687 | 2017-01-31 |
| 1578965422 | Jorge Domingo Reyes | Counselor | 5700 E. Franklin Rd., Suite 220-i, Nampa, ID 83687 | 2014-09-23 |
| 1619302080 | David Lyle Farris | Dentist | 16548 North Franklin Blvd., Nampa, ID 83687 | 2013-09-04 |
| 1871934547 | Ian Zafar Qureshi | Internal Medicine | 4400 E Flamingo Ave Ste 130, Nampa, ID 83687 | 2013-07-10 |
| 1457696783 | Laurel Evans | Specialist/Technologist | 850 W. St. Luke's Dr., Suite 215, Nampa, ID 83687 | 2012-11-27 |
| 1750641197 | Andrea Patricia Fitzer | Nurse Practitioner | 4400 E. Flamingo Ave, Nampa, ID 83687 | 2012-05-18 |
| 1679846182 | Ivony Case Management | Case Management | 811 12th Street, Ste. 2, Nampa, ID 83687 | 2012-02-14 |
| 1699043679 | Saltzer Medical Group, P.a. | Durable Medical Equipment & Medical Supplies | 9850 W St Lukes Drive, Nampa, ID 83687 | 2011-12-06 |
| Find all providers in zip 83687 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699763540 | Phillip Neil Burk | Podiatrist | 203 12th Ave Rd, Suite A, Nampa, ID 83686-5012 | 2005-10-13 |
| 1235575044 | Troy W. Fowler | Podiatrist | 203 12th Ave Rd, Nampa, ID 83686-5012 | 2013-05-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558968750 | Family Foot and Ankle of Idaho, LLC | Podiatrist | 349 W Bacall Dr, Meridian, ID 83646-7391 | 2020-10-01 |
| 1740824762 | Idaho Complete Foot Care | Podiatrist | 880 Redman St, Chubbuck, ID 83202-2655 | 2019-11-01 |
| 1346883261 | Monarch Medical LLC | Podiatrist | 423 N 3rd Ave Ste 110, Sandpoint, ID 83864-1511 | 2019-10-23 |
| 1326496910 | Advanced Foot & Ankle of Magic Valley, Pllc | Podiatrist | 176 Falls Ave Ste 200, Twin Falls, ID 83301-2306 | 2016-05-25 |
| 1629223110 | Kyle R. Yorgason | Podiatrist | 1075 N Curtis Rd Ste 300, Boise, ID 83706-1348 | 2008-11-25 |
| 1609085455 | Craig D Holman Chartered | Podiatrist | 496 Shoup Ave W # B, Twin Falls, ID 83301-5043 | 2007-05-21 |
| 1669516738 | Valley Foot & Ankle, PC | Podiatrist | 1455 Bench Rd Ste B, Pocatello, ID 83201-5084 | 2007-02-20 |
| 1629111497 | Michael K. James | Podiatrist | 3345 S Holmes Ave, Idaho Falls, ID 83404-7981 | 2007-02-14 |
| 1790864619 | Valley Foot & Ankle, PC | Podiatrist | 1455 Bench Rd, Suite B, Pocatello, ID 83201 | 2006-11-02 |
| 1629185426 | Ronald Ray Vogel | Podiatrist | 12717 N Avondale Loop, Hayden, ID 83835-7531 | 2006-08-25 |
| 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.