MR. MICHAEL L MART (NPI# 1598861379) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598861379 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL L MART |
| Credential | PAC |
| Practice Address |
190 E Bannock St Boise ID 83712-6241 |
| Practice Telephone | 2087067500 |
| Practice Fax Number | 2087067501 |
| Mailing Telephone | 2087067500 |
| Mailing Fax Number | 2087067501 |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2017-03-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA77 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
190 E BANNOCK ST |
| City | BOISE |
| State | ID |
| Zip Code | 83712-6241 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770586794 | St Lukes Regional Medical Center | Pharmacy | 190 E Bannock St, Boise, ID 83712-6241 | 2005-05-23 |
| 1275133944 | St Lukes Health System Ltd | General Acute Care Hospital | 190 E Bannock St, Boise, ID 83712-6241 | 2020-10-30 |
| 1750980017 | Andrea Johnson Murray | Pharmacy Technician | 190 E Bannock St, Boise, ID 83712-6241 | 2020-10-19 |
| 1679180103 | Katie Marie Pond | Social Worker | 190 E Bannock St, Boise, ID 83712-6241 | 2020-09-29 |
| 1780297762 | Alexandria Marie Schultz | Pharmacist | 190 E Bannock St, Boise, ID 83712-6241 | 2020-08-28 |
| 1225640048 | Tania Michelle Villanueva-sanchez | Pharmacist | 190 E Bannock St, Boise, ID 83712-6241 | 2020-08-21 |
| 1154931426 | Brittany Nichole Galop | Pharmacist | 190 E Bannock St, Boise, ID 83712-6241 | 2020-08-03 |
| 1558970046 | Emily Michelle Bush | Pharmacist | 190 E Bannock St, Boise, ID 83712-6241 | 2020-07-30 |
| 1699393447 | Chadd Miller Ramos | Pharmacist | 190 E Bannock St, Boise, ID 83712-6241 | 2020-07-08 |
| 1740819127 | Lindzee Searle | Pharmacy Technician | 190 E Bannock St, Boise, ID 83712-6241 | 2020-04-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477016012 | Veranda At Barber Station LLC | Assisted Living Facility | 3266 E. Barber Valley Drive, Boise, ID 83712 | 2019-04-10 |
| 1891258612 | Mary Elizabeth Riedel | Occupational Therapist | 190 E Bancock St., Boise, ID 83712 | 2019-04-09 |
| 1427523968 | Q17 Health Partners LLC | Surgery | 100 East Idaho Street #317, Boise, ID 83712 | 2018-10-11 |
| 1053898247 | Travis Dale Worwood | Social Worker | South Entrance, 1075 E. Park Blvd, Boise, ID 83712 | 2018-07-20 |
| 1689166761 | Kristen Nicole Ray | Social Worker | 109 E Bannock St, Boise, ID 83712 | 2018-06-04 |
| 1740706894 | Meghan Heitstuman | Social Worker | 190 E Bannock Street, Boise, ID 83712 | 2017-08-21 |
| 1942759725 | Kay Craig | Physical Therapist | 190 Bannock, Boise, ID 83712 | 2016-09-22 |
| 1235686395 | Sharon Bjornson | Physical Therapist | 190 East Bannack, Boise, ID 83712 | 2016-09-07 |
| 1033576491 | Heather Hussey | Genetic Counselor, MS | 100 E Idaho Street, Msti Genetics, Boise, ID 83712 | 2016-01-15 |
| 1295139137 | Amie Bartholomeus | Massage Therapist | 100 East Idaho Street, St Luke's Mountain States Tumor Institute, Boise, ID 83712 | 2014-10-21 |
| Find all providers in zip 83712 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073915963 | Jessica Bishop | Physician Assistant | 1499 W Hays St, Boise, ID 83702-5029 | 2014-09-23 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1710231238 | Alaina A Mccoy | Physician Assistant | 100 E. Idaho St., Suite 400, Boise, ID 83712 | 2012-11-06 |
| 1447534821 | Addie Barnes | Physician Assistant | 900 N Liberty, Ste 101, Boise, ID 83704 | 2011-10-04 |
| 1134358104 | Eric Culbertson | Physician Assistant | 633n 4th St, Boise, ID 83702-4510 | 2009-07-10 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1598921595 | Karen B. Barrett | Physician Assistant | 6000 W. Overland Road, Firstline Medical, Boise, ID 83704 | 2008-07-30 |
| 1972672111 | Kara Mcgee | Physician Assistant | 727 E Riverpark Ln Ste 200, Boise, ID 83706-4097 | 2006-11-06 |
| 1265464036 | Sharene E Watsen | Physician Assistant | 403 South 11th St, Ste 100, Boise, ID 83702-6906 | 2006-07-06 |
| 1508802091 | Heidi R Munro | Physician Assistant | 8000 S Federal Way, Boise, ID 83716-9632 | 2006-06-22 |
| Find all providers in BOISE | ||||
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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.