James Picanco Sr., P.A.-C
Individual provider Active NPI Physician Assistant · Fort Hall, ID
NPI 1407862139 · NPPES record last updated Jul 18, 2007
Key facts
- NPI
- 1407862139
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA01153 (TX)
- Practice address
- Mission Road
Fort Hall, ID 83203-0717 - Phone
- (208) 238-5427
- Fax
- (208) 238-5465
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA01153 | TX | Yes |
Addresses
Primary practice location
Mission Road
Fort Hall, ID 83203-0717
Mailing address
Mission Road
Fort Hall, ID 83203-0717
Phone (208) 238-5427
Other providers in Fort Hall, ID
- Not-Tsoo Gah-Nee Indian Health Center
- Not-Tsoo Gah-Nee Indian Health Center Pharmacy
- Not-Tsoo Gah-Nee Indiane Health Services
- Sandra Ortiz
- Kevin Pendlebury
- Brandy Pugmire
- Nava Reneda
- Catherine Tammy Salisbury
- Shoshone Bannock Hotel & Event Center
- Shoshone Bannock Tribes
All providers in Fort Hall, ID · Physician Assistant in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.