ADA WEST DERMATOPATHOLOGY, LLC (NPI# 1760730436) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760730436 |
| Entity Type | Organization |
| Organization Name | ADA WEST DERMATOPATHOLOGY, LLC |
| Practice Address |
1618 Millenium Way Ste 220 Meridian ID 83642-6439 |
| Practice Telephone | 2088843376 |
| Practice Fax Number | 2088840858 |
| Mailing Telephone | 2088843376 |
| Mailing Fax Number | 2088840858 |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2018-11-15 |
| Authorized Official Name | DR. RANDALL BURR (OWNER) |
| Authorized Official Telephone | 2088843376 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | ADA WEST DERMATOLOGY, PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | P1629 | ID | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | MEDICARE PTAN | 20002043 | 01 |
| Street Address |
1618 MILLENIUM WAY STE 220 |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642-6439 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154380293 | Pamela A Martin | Physical Therapist | 1618 Millenium Way, Suite 210, Meridian, ID 83642-6439 | 2006-03-18 |
| 1740439470 | Nicole Olsen | Physical Therapist | 1618 Millenium Way, Ste 210, Meridian, ID 83642-6439 | 2008-09-18 |
| 1851457675 | Foothills Physical Therapy Pa | Specialist | 1618 Millenium Way, Suite 210, Meridian, ID 83642-6439 | 2006-12-28 |
| 1154489821 | Alan J A Pitt Md P A | Dermatology | 1618 Millenium Way, #100, Meridian, ID 83642-6439 | 2006-12-05 |
| 1437266723 | Lauren W Scott | Physical Therapist | 1618 Millenium Way, Suite 210, Meridian, ID 83642-6439 | 2006-08-24 |
| 1871609370 | Gregory L Wells | Dermatology | 1618 Millenium Way, Suite 100, Meridian, ID 83642-6457 | 2006-08-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| Find all providers in zip 83642 | ||||
| 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 |
|---|---|---|---|---|
| 1730786328 | Idaho One Health Network, LLC | Clinical Medical Laboratory | 4455 S Meridian Rd, Meridian, ID 83642-6917 | 2020-10-06 |
| 1437517042 | Premier Laboratories of Ms | Clinical Medical Laboratory | 2308 25th St, Meridian, MS 39301-2123 | 2016-02-10 |
| 1457722092 | Bear Tooth Laboratory, LLC | Clinical Medical Laboratory | 1125 E Pine Ave, Ste B, Meridian, ID 83642-5955 | 2015-10-08 |
| 1467857102 | Medical Foundation, Inc. | Clinical Medical Laboratory | 1306 20th Avenue, Meridian, MS 39301 | 2014-10-23 |
| 1942444559 | Daystar Labs Happy Heart Screening | Clinical Medical Laboratory | 2874 N Mule Deer Way, Meridian, ID 83646-7812 | 2009-04-27 |
| 1730349317 | Laboratory Corporation of America | Clinical Medical Laboratory | 1965 S Eagle Rd Ste 130, Meridian, ID 83642-9287 | 2008-06-17 |
| 1659482529 | Diagnostic Tissue/cytology Group, Pllc | Clinical Medical Laboratory | 1512 20th Ave, Meridian, MS 39301-4124 | 2006-08-31 |
| 1427036615 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 2701 Davis St, Meridian, MS 39301-5708 | 2006-01-06 |
| 1306822960 | Meridian Arts Surgical Group Vascular Lab, LLC | Clinical Medical Laboratory | 2111 14th St, Meridian, MS 39301-4041 | 2005-12-15 |
| 1891770400 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 606 22nd Ave, Meridian, MS 39301-5021 | 2005-12-07 |
| Find all providers in MERIDIAN | ||||
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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.