Idaho Dermatologic Surgery & Laser Center Pa

LBN: Idaho Dermatologic Surgery & Laser Center Pa
Idaho Dermatologic Surgery & Laser Center Pa is an health care organization with primary practice located at 1488 N Knights Dr , Boise ID 83712-6557. The organization recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, Allopathic & Osteopathic Physicians / Procedural Dermatology, Ambulatory Health Care Facilities / Medical Specialty. Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery is the primary health care specialty. Idaho Dermatologic Surgery & Laser Center Pa can be contacted via phone (208) 345-4050, or through Cottingham, Teri J via phone (208) 869-2869.

Contact Information

Primary practice address
1488 N Knights Dr Boise ID 83712-6557
Phone: (208) 345-4050
Fax: (208) 327-9524
Website:
Map and Directions
Authorized official contact:
Name: Cottingham, Teri J Doctor of Medicine (MD)
Phone: (208) 869-2869

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X M-7506 Idaho
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X M-7506 Idaho
Allopathic & Osteopathic Physicians / Procedural Dermatology 207NS0135X M-7506 Idaho
Ambulatory Health Care Facilities / Medical Specialty 261QM2500X

Profile Details

NPI number 1649478454
LBN Legal business name Idaho Dermatologic Surgery & Laser Center Pa
DBA Doing business as
Authorized official Cottingham, Teri J Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jul 3rd, 2007
Last updated Feb 23rd, 2024 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649478454 NPPES
Idaho Other 1139318 PTAN
Idaho MEDICAID 805151100 PTAN

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