IDAHO MEMORY & AGING CENTER PLLC (NPI# 1730528548) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730528548 |
| Entity Type | Organization |
| Organization Name | IDAHO MEMORY & AGING CENTER PLLC |
| Practice Address |
413 N Allumbaugh St Ste# 101 Boise ID 83704-9212 |
| Practice Telephone | 6179224957 |
| Mailing Telephone | 6179224957 |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2013-07-19 |
| Authorized Official Name | DR. ABHILASH K DESAI (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 6179224957 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0805X |
Psychiatry & Neurology Specialization: Geriatric Psychiatry |
M-12079 | ID | Allopathic & Osteopathic Physicians |
| Street Address |
413 N ALLUMBAUGH ST STE# 101 |
| City | BOISE |
| State | ID |
| Zip Code | 83704-9212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245221258 | Brady G Hamilton | Physician Assistant | 413 N Allumbaugh St, Suite 101, Boise, ID 83704-9212 | 2005-10-31 |
| 1518414606 | Emmy Laurie Weathers | Social Worker | 413 N Allumbaugh St, Suite 101, Boise, ID 83704-9212 | 2016-09-06 |
| 1548610272 | Tamara Helfer, M.d., Pllc | Psychiatry & Neurology | 413 N Allumbaugh St, Suite 101, Boise, ID 83704-9212 | 2016-06-14 |
| 1598129728 | Matthew D Pitcher, Do Pllc | Psychiatry & Neurology | 413 N Allumbaugh St, Suite 101, Boise, ID 83704-9212 | 2016-04-13 |
| 1972906824 | Katherine Skelly | Physician Assistant | 413 N Allumbaugh St, Suite 101, Boise, ID 83704-9212 | 2014-10-07 |
| 1114335221 | Mark A Jepson Pllc | Registered Nurse | 413 N Allumbaugh St, Ste. 101, Boise, ID 83704-9212 | 2014-08-01 |
| 1265855118 | Jeremy Handy, M.d., Pllc | Psychiatry & Neurology | 413 N Allumbaugh St, Suite 101, Boise, ID 83704-9212 | 2014-01-29 |
| 1245597509 | Gail Robison Np Pllc | Nurse Practitioner | 413 N Allumbaugh St, Suite 101, Boise, ID 83704-9212 | 2012-04-11 |
| 1649536418 | Travis Paul Haase | Counselor | 413 N Allumbaugh St, Suite 101, Boise, ID 83704-9212 | 2012-04-05 |
| 1710250543 | Coire Weathers, Md, Pllc | Psychiatry & Neurology | 413 N Allumbaugh St, Suite 101, Boise, ID 83704-9212 | 2012-02-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215535893 | Laura Diggs | Counselor | 400 North Benjamin Lane, Suite 200, Boise, ID 83704 | 2020-10-15 |
| 1891304002 | Tree City Family Dental | Dentist | 7301 W. Emerald St Ste. 102, Boise, ID 83704 | 2020-07-24 |
| 1982230710 | Jessica Wynn Councell | Midwife | 1072 N Liberty St Ste 100, Boise, ID 83704 | 2020-03-12 |
| 1699307124 | Isabel Burns Bruce | Registered Nurse | 777 N Raymond Street, Boise, ID 83704 | 2020-02-12 |
| 1558903328 | Daring In Idaho, LLC | Social Worker | 413 N Allumbaugh Street, Suite 102, Boise, ID 83704 | 2019-10-14 |
| 1053960286 | Kyle Hiromi Hatanaka | Acupuncturist | 9450 #120 Fairview Avenue, Boise, ID 83704 | 2019-09-10 |
| 1700447141 | Katie Elizabeth Nichols | Physician Assistant | 1072 N Liberty St Ste 201, Boise, ID 83704 | 2019-06-26 |
| 1588164727 | Cory Michael Sims | Counselor | 6550 W. Emerald St #112, Boise, ID 83704 | 2018-02-14 |
| 1477072270 | Matthew Lee Love | Non-emergency Medical Transport (VAN) | 6933 W. Stratton St, Boise, ID 83704 | 2017-09-12 |
| 1942735949 | Dalana Sue Thompson | Counselor | 9196 Emerald St Suite #130, Boise, ID 83704 | 2017-04-27 |
| Find all providers in zip 83704 | ||||
| Taxonomy Code | 2084P0805X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Geriatric Psychiatry |
| Geriatric Psychiatry is a subspecialty with psychiatric expertise in prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly, and improvement of psychiatric care for healthy and ill elderly patients. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417390741 | Reiko Joy Emtman | Psychiatry & Neurology | 500 W Fort St # B114, Boise, ID 83702-4501 | 2013-04-17 |
| 1164574372 | Frank Alan Germano | Psychiatry & Neurology | 7267 Potomac Dr, Boise, ID 83704-9150 | 2007-01-17 |
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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.