Physician Skin Care

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2082807848 Issued in ID

Legal business name

PHYSICIAN SKIN CARE

Practice address

730 S Woodruff Ave
Idaho Falls, ID 83401-5285

Phone

(208) 542-9111

NPI assigned

Feb 15, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Candace Marie Bunnage

Title

Billing Manager

Phone

(208) 542-9111

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023151156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015285",
            "telephone_number": "208-542-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015285",
            "telephone_number": "208-542-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SKIN CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUNNAGE",
        "authorized_official_first_name": "CANDACE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "208-542-9111",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "2082807848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James William Phillippi, D.O.
• Caleb Milton Phillips
• Gabriel Phillips, PHARMD
• Renee Phillips
• Taylor Mark Phillips
• Physician's Choice Cardiology, PLLC
• Physio Shop Idaho LLC
• Claudia Isabel Picazzo, AMFT
• Amber Pichinte
• Pick PT Ammon LLC (Pick PT)

• Family Medicine Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.