Southeast Idaho Gastroenterology,PLLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

SOUTHEAST IDAHO GASTROENTEROLOGY,PLLC

Practice address

1151 Hospital Way BLDG a
Pocatello, ID 83201-2763

Phone

(208) 232-6616

Fax

(208) 232-6618

NPI assigned

Jul 19, 2006

Organization subpart

No

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

Authorized official

Name

Darryl Bruce Cook, M.D.

Title

Member

Phone

(208) 232-6616

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Shad Carl Johnson, PA-C

  • Medical Physician Assistant
  • Pocatello, ID
  • NPI 1114028354

  Gastroenterology

  NPD

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348531200000",
    "number": "1295754265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4788",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832054788",
            "telephone_number": "208-232-6616",
            "fax_number": "208-232-6618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 HOSPITAL WAY BLDG A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012763",
            "telephone_number": "208-232-6616",
            "fax_number": "208-232-6618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST IDAHO GASTROENTEROLOGY,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2012-09-25",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "208-232-6616",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002803000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Park, Inc.
• South Park, Inc.
• South Park, Inc.
• Southeast Idaho Council of Governments
• Southeast Idaho Gastroenterology, PLLC
• Southeast Idaho Orthodontics, PLLC
• Southeastern District Health Department
• Southeastern District Health Department
• Southeastern District Health Dept.
• Katrina E Spangenberg, MD

• Gastroenterology Physician in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Gastroenterology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; 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.