Keith E Davis, M.D.
Individual provider Active NPI Family Medicine Physician · Shoshone, ID
NPI 1043277635 · NPPES record last updated Nov 15, 2010
Key facts
- NPI
- 1043277635
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- M4888 (ID)
- Practice address
- 113 S Apple St
Shoshone, ID 83352-5287 - Phone
- (208) 886-2224
- Fax
- (208) 886-2634
- NPI assigned
- Apr 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 17
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031118000654 | ID | Practitioner - Family Practice | 2668384702 |
Reassigns benefits to 1 organization Practice locations: Shoshone, ID |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4888 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Services Corporation | Family Medicine | Current | Accepting new patients |
| Family Health Services Corporation | Family Medicine | Current | Accepting new patients |
| Southern Idaho Diabetes Education Program | Current |
Accepting new patients | |
| Family Health Services Corporation | Family Medicine | Current |
Accepting new patients |
| Family Health Services Corporation | Family Medicine | Current | Accepting new patients |
| Family Health Services Corporation | Current |
Accepting new patients | |
| Family Health Services Corporation | Family Medicine | Current | Accepting new patients |
| Family Health Services Corporation | Family Medicine | Past | Accepting new patients |
| Family Health Services Corporation | Family Medicine | Past | Accepting new patients |
| Family Health Services Corporation | Past | Accepting new patients | |
| Lincoln County EMS | Past |
Accepting new patients | |
| Family Health Services Corporation | Family Medicine | Past | Accepting new patients |
| Family Health Services Corporation | Family Medicine | Past | Accepting new patients |
| Family Health Services Corporation | Family Medicine | Past | Accepting new patients |
| Andrew L McCall DPM PA | Past | Accepting new patients | |
| Family Health Services Corporation | Family Medicine | Past | Accepting new patients |
| Family Health Services Corporation | Family Medicine | Past | Accepting new patients |
Locations
621 N Main St
Bellevue, ID 83313
Phone (208) 725-3145
725 Fair St
Buhl, ID 83316
Phone (208) 543-8271
1309 Bennett Ave
Burley, ID 83318
Phone (208) 677-5198
114 Pioneer Ct
Jerome, ID 83338
Phone (208) 324-3471
218 W Nez Perce
Jerome, ID 83338
Phone (208) 324-3471
402 6th St
Rupert, ID 83350
Phone (208) 650-7941
113 S Apple St
Shoshone, ID 83352
Phone (208) 886-2224
651 S Beverly St
Shoshone, ID 83352
Phone (208) 886-2224
325 Martin St
Twin Falls, ID 83301
Phone (208) 732-7101
794 Eastland Dr
Twin Falls, ID 83301
Phone (208) 734-3312
801 Pole Line Rd W
Twin Falls, ID 83301
Phone (208) 814-1000
388 Martin St
Twin Falls, ID 83301
Phone (208) 734-0451
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- keith.davis.d1.p1@direct.fhsid.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M4888 | ID | Yes |
Addresses
Primary practice location
113 S Apple St
Shoshone, ID 83352-5287
Mailing address
113 S. Apple St.
PO Box 609
Shoshone, ID 83352-0609
Phone (208) 886-2224
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001801000 | Medicaid | ID | |
| 133841 | Other | RHC |
Other providers in Shoshone, ID
- Ahs of Idaho
- Melissa Brown
- Cascades at Lincoln County, LLC
- Charolais Care IV, Inc
- Martha Mary Clements
- Katelyn Rose Denison
- Family Health Services Corporation
- Family Health Services Corporation
- Gooding Pharmacy Inc
- Barbara Hapayan
All providers in Shoshone, 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 Nov 15, 2010. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.