JOHN M WICK (NPI# 1982657375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982657375 |
| Entity Type | Individual |
| Full Name | JOHN M WICK |
| Credential | MD |
| Practice Address |
703 S Americana Blvd Ste 120 Boise ID 83702-6754 |
| Mailing Address |
190 E Bannock St Boise ID 83712-6241 |
| Practice Telephone | 2088945543 |
| Mailing Telephone | 2088876813 |
| Mailing Fax Number | 2088876884 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2017-10-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | M8339 | ID | Allopathic & Osteopathic Physicians |
| N | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
M-8339 | ID | Allopathic & Osteopathic Physicians |
| Street Address |
703 S AMERICANA BLVD STE 120 |
| City | BOISE |
| State | ID |
| Zip Code | 83702-6754 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235630732 | Emily Anne Flannery | Specialist/Technologist | 703 S Americana Blvd Ste 120, Boise, ID 83702-6754 | 2018-02-21 |
| 1568900769 | Logan Ellis | Specialist/Technologist | 703 S Americana Blvd Ste 120, Boise, ID 83702-6754 | 2017-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
| 1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
| 1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
| 1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
| 1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
| 1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
| 1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
| 1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
| 1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
| 1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
| Find all providers in zip 83702 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790269389 | Erin Michelle Love Mcdermott | Family Medicine | 2402 W Jefferson St, Boise, ID 83702-4811 | 2018-09-19 |
| 1336656040 | Functional Medicine of Idaho PC | Family Medicine | 3858 N Garden Center Way Ste 100, Boise, ID 83703-5008 | 2018-01-03 |
| 1922456870 | Daniel Luftig | Family Medicine | 1041 S Dale St Apt 302, Boise, ID 83706-7641 | 2016-06-01 |
| 1942676598 | Robert F. Smith, Md, Pllc | Family Medicine | 320 N Collins Rd, Boise, ID 83702-4519 | 2015-08-18 |
| 1861827222 | Treasure Valley Neuropathy Relief Center PC | Family Medicine | 1755 N Westgate Dr, Suite 200, Boise, ID 83704-7174 | 2013-09-04 |
| 1205272986 | Shahla Walizada | Family Medicine | 2141 E Parkcenter Blvd, Samg Bhp Family Medicine, Boise, ID 83706 | 2013-05-21 |
| 1891057246 | Kara Mackenzie Kuntz | Family Medicine | 5966 W Curtisian Road, Boise, ID 83704 | 2012-06-12 |
| 1922366707 | Cottonwood Family Medicine | Family Medicine | 100 Cottonwood Court, Suite 150, Boise, ID 87616 | 2012-04-30 |
| 1720377476 | Steven Schneider | Family Medicine | 3775 W Quail Hollow Dr, Boise, ID 83703-3869 | 2011-04-04 |
| 1922311042 | Amber Vania | Family Medicine | 4971 W. Overland Road, Boise, ID 83705 | 2010-07-18 |
| 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.