NPIMap

Organization Active NPI

Asthma & Allergy of Idaho

  • Nurse Practitioner
  • Twin Falls, ID
National Provider Identifier
1265635171
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ASTHMA & ALLERGY OF IDAHO
Practice address
1502 Locust St N Ste 600
Twin Falls, ID 83301-4164
Phone
(208) 734-6091
Fax
(208) 734-4654
NPI assigned
Jun 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

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

Authorized official

Name
Andrew Wickern
Title
Credentialing Specialist
Phone
(208) 734-6091

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

1502 Locust St N Ste 600
Twin Falls, ID 83301-4164

Mailing address

1502 Locust St N Ste 600
Twin Falls, ID 83301-4164
Phone (208) 734-6091

Other names 1

  • Asthma & Allergy of Idaho mid level group Other name

National Provider Directory

National Provider Directory
Tax ID family
Asthma Allergy of Idaho2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1502 Locust St N
Ste 600
Twin Falls, ID 83301
Phone (208) 734-6091

800 Falls Ave
Ste 2
Twin Falls, ID 83301
Phone (208) 734-6091

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610582400000",
    "number": "1265635171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 LOCUST ST N STE 600",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014164",
            "telephone_number": "208-734-6091",
            "fax_number": "208-734-4654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 LOCUST ST N STE 600",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014164",
            "telephone_number": "208-734-6091",
            "fax_number": "208-734-4654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASTHMA & ALLERGY OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A",
        "authorized_official_last_name": "WICKERN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "208-734-6091"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Asthma & Allergy of Idaho mid level group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Asthma & Allergy of Idaho mid level group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; 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.