Thomas E Archie Jr., M.D.
Individual provider Active NPI Family Medicine Physician · Hailey, ID
NPI 1023073897 · NPPES record last updated Jul 24, 2013
Key facts
- NPI
- 1023073897
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- M10114 (ID)
- Practice address
- 1450 Aviation Dr
Suite 100
Hailey, ID 83333-8785 - Phone
- (208) 788-3434
- Fax
- (208) 788-2025
- NPI assigned
- Apr 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 1, 2016 through Jul 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M10114 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Luke'S Clinic LLC | Family Medicine | Past |
Accepting new patients |
| East Morgan County Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M10114 | ID | Yes |
| Acupuncturist | 171100000X | M10114 | ID |
Addresses
Primary practice location
1450 Aviation Dr
Suite 100
Hailey, ID 83333-8785
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00697901 | Other | ID | MCRR |
| 807891600 | Medicaid | ID |
Other providers in Hailey, ID
- Darcy Amick
- Christie Burnett Anderson
- Joan Marie Anderson
- Frank Andrews
- Arc Physical Therapy, PLLC
- Yolanda Arriaga Franco
- Aspire Physical Therapy
- Aspire Physical Therapy, PLLC
- Atkinsons Market, Inc
- Susan Ayers
All providers in Hailey, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.