SOUTHEAST IDAHO GASTROENTEROLOGY, PLLC (NPI# 1780867457) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780867457 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST IDAHO GASTROENTEROLOGY, PLLC |
| Practice Address |
1151 Hospital Way Ste A Pocatello ID 83201-5091 |
| Practice Telephone | 2082326616 |
| Practice Fax Number | 2082326618 |
| Mailing Telephone | 2082326616 |
| Mailing Fax Number | 2082326618 |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2007-12-17 |
| Authorized Official Name | DEBBIE J FERREL (PRACTICE MANAGER) |
| Authorized Official Telephone | 2082326616 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA-629 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 806196200 | 05 |
| Street Address |
1151 HOSPITAL WAY STE A |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-5091 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720379597 | Lance W Mckay | Physician Assistant | 1151 Hospital Way, Bld D, Pocatello, ID 83201-5091 | 2011-04-27 |
| 1467602920 | Stephanie Theresa Hanson | Physician Assistant | 11460 N Philbin Rd, Pocatello, ID 83202-5306 | 2008-09-22 |
| 1174711758 | Rsm Pa Pllc | Physician Assistant | 1595 Bannock Hwy, Pocatello, ID 83204 | 2007-10-09 |
| 1760597462 | Karen Dickerson | Physician Assistant | 1352 E Center St, Pocatello, ID 83201-4734 | 2006-08-20 |
| 1265441547 | Nicole Manning | Physician Assistant | 475 Yellowstone Ave, Ste E, Pocatello, ID 83201-4528 | 2006-08-05 |
| 1124040506 | Michael John Doyle | Physician Assistant | 921 S 8th Ave Stop 8311, Pocatello, ID 83209-0002 | 2006-07-24 |
| 1417909862 | Cynthia Ann Bunde | Physician Assistant | 429 Washington Ave, Pocatello, ID 83201-4520 | 2006-05-16 |
| 1750342952 | Kebai Dawn Bills | Physician Assistant | 1777 E. Clark Suite # 210, Pocatello, ID 83201 | 2006-03-29 |
| 1073513065 | Helena M. B. Rizor | Physician Assistant | 1448 E Center St, Pocatello, ID 83201-4105 | 2005-07-30 |
| 1376946012 | Angela G Hatch | Physician Assistant | 777 Hospital Way, Pocatello, ID 83201-5175 | 2014-10-08 |
| Find all providers in POCATELLO | ||||
Please comment or provide details below to improve the information on SOUTHEAST IDAHO GASTROENTEROLOGY, PLLC.
| 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.