Active NPI
Makell Brugger, CST
- Surgical Technologist
- Eagle, ID
National Provider Identifier
1205159803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- 96662
- Practice address
- 323 E Riverside Dr
Suite 234
Eagle, ID 83616-6864 - Phone
- (208) 938-4080
- Fax
- (208) 938-8922
- NPI assigned
- Mar 10, 2010
- Last updated
- Mar 10, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | 96662 | ID | Primary |
Addresses
Primary practice location
323 E Riverside Dr
Suite 234
Eagle, ID 83616-6864
Mailing address
323 E Riverside Dr
Suite 234
Eagle, ID 83616-6864
Phone (208) 938-4080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 96662 | ID | MD | Surgical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268179200000",
"number": "1205159803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "323 E RIVERSIDE DR",
"address_2": "SUITE 234",
"city": "EAGLE",
"state": "ID",
"postal_code": "836166864",
"telephone_number": "208-938-4080",
"fax_number": "208-938-8922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "323 E RIVERSIDE DR",
"address_2": "SUITE 234",
"city": "EAGLE",
"state": "ID",
"postal_code": "836166864",
"telephone_number": "208-938-4080",
"fax_number": "208-938-8922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUGGER",
"first_name": "MAKELL",
"credential": "CST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-10",
"last_updated": "2010-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": "ID",
"license": "96662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.