Idaho Falls Dermatology P A

LBN: Idaho Falls Dermatology P A
Idaho Falls Dermatology P A is an health care organization with primary practice located at 2001 S Woodruff Ave Ste 12A, Idaho Falls ID 83404-6374. The organization recently has only one registered license in Other Service Providers / Specialist, which is considered as the primary health care specialty. Idaho Falls Dermatology P A can be contacted via phone (208) 522-8945, or through Brooke, Cornelius Paul via phone (208) 522-8945.

Contact Information

Primary practice address
2001 S Woodruff Ave Ste 12A Idaho Falls ID 83404-6374
Phone: (208) 522-8945
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Brooke, Cornelius Paul
Phone: (208) 522-8945

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 5809M Idaho

Profile Details

NPI number 1487700464
LBN Legal business name Idaho Falls Dermatology P A
DBA Doing business as
Authorized official Brooke, Cornelius Paul
Entity Organization
Organization subpart 1 No
Enumeration date Jan 25th, 2007
Last updated Jul 5th, 2016 - about 10 years ago

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 1487700464 NPPES
Idaho MEDICAID 807962200
Idaho Other 77186

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