Travis L Taylor (NPI# 1255597811, PAC ID# 5597989897) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1255597811 |
| PAC ID by PECOS | 5597989897 |
| Professional Enrollment ID | I20140606000279 |
| Full Name | Travis L Taylor |
| Organization Legal Name | MICHAEL R DIBENEDETTO MD PLLC |
| Address |
30544 Hwy 200 Suite 102 Ponderay ID 83852-5005 |
| Phone Number | 2082659817 |
| Gender | M |
| Graduation Year | 2013 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 0840385670 |
| Number of Group Practice Members | 8 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 131328 | BONNER GENERAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2082673141 | BOUNDARY COMMUNITY HOSPITAL |
| 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 | 2082659817 | MICHAEL R DIBENEDETTO MD PLLC |
| Organization Legal Name | MICHAEL R DIBENEDETTO MD PLLC |
| Physicians | 7 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Joan M Bloom | Family Medicine | Michael R Dibenedetto Md Pllc | 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 |
| Lindsey M Ruppel | Family Medicine | Michael R Dibenedetto Md Pllc | 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 |
| Michael R Di Benedetto | Orthopedic Surgery | Michael R Dibenedetto Md Pllc | 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 |
| Michael D Schicker | Orthopedic Surgery | Michael R Dibenedetto Md Pllc | 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 |
| Jonathan D Fisher | Podiatry | Michael R Dibenedetto Md Pllc | 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 |
| Darwin L Hurst | Nurse Practitioner | Michael R Dibenedetto Md Pllc | 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 |
| Street Address |
30544 HWY 200 SUITE 102 |
| City | PONDERAY |
| State | ID |
| Zip | 83852-5005 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Joan M Bloom | Family Medicine | Michael R Dibenedetto Md Pllc | 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 |
| K Garrett Fischer | Physical Therapy | Kauai In-home Therapy LLC | 30544 Hwy 200, Ponderay, ID 83852-5005 |
| Lindsey M Ruppel | Family Medicine | Michael R Dibenedetto Md Pllc | 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 |
| Michael R Di Benedetto | Orthopedic Surgery | Michael R Dibenedetto Md Pllc | 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 |
| Michael D Schicker | Orthopedic Surgery | Michael R Dibenedetto Md Pllc | 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 |
| Jonathan D Fisher | Podiatry | Michael R Dibenedetto Md Pllc | 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 |
| Darwin L Hurst | Nurse Practitioner | Michael R Dibenedetto Md Pllc | 30544 Hwy 200, Suite 102, Ponderay, ID 83852-5005 |
| Jonathan Roy Gardunia | Physical Therapy | Kauai In-home Therapy LLC | 30544 Hwy 200, Ponderay, ID 83852-5005 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Bruce W Demko | Certified Registered Nurse Anesthetist (crna) | 30544 Hwy 200 201, Ponderay, ID 83852-5005 | |
| Benjamin C Ringger | Dermatology | North Idaho Dermatology Pa | 476394 Hwy 95, Ponderay, ID 83852-5014 |
| Shannon K Mortensen | Nurse Practitioner | North Idaho Dermatology Pa | 476394 Hwy 95, Ponderay, ID 83852-5014 |
| Richard A Flygare | Physician Assistant | North Idaho Dermatology Pa | 476394 Hwy 95, Ponderay, ID 83852-5014 |
| Craig A Rodriguez | Physician Assistant | North Idaho Dermatology Pa | 476394 Hwy 95, Ponderay, ID 83852-5014 |
| Stephen D Craig | Dermatology | North Idaho Dermatology Pa | 476394 Hwy 95, Ponderay, ID 83852-5014 |
| Dustin G Larsen | Dermatology | North Idaho Dermatology Pa | 476394 Hwy 95, Ponderay, ID 83852-5014 |
| Hilary H Hill | Dermatology | North Idaho Dermatology Pa | 476394 Hwy 95, Ponderay, ID 83852-5014 |
| Ann Cox | Nurse Practitioner | Boundary Regional Community Health Center, Inc. | 30410 Hwy 200, Ponderay, ID 83852-9601 |
| Erin Bass | Nurse Practitioner | Boundary Regional Community Health Center, Inc. | 30410 Hwy 200, Ponderay, ID 83852-9601 |
| Find all physicians in zip 83852 | |||
| City | PONDERAY |
| Zip Code | 83852 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | PONDERAY + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Travis L Taylor.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.