NPIMap

Organization Active NPI

Bruce C McComas, M. D., P. a.

Doing business as Southern Idaho Vein Care Center

  • Surgery Physician
  • Twin Falls, ID
National Provider Identifier
1407894041
Registry record updated Mar 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
M5070 Issued in ID
Legal business name
BRUCE C MCCOMAS, M. D., P. A.
Doing business as
Southern Idaho Vein Care Center
Practice address
775 Pole Line Rd W
Suite 212
Twin Falls, ID 83301-5814
Phone
(208) 814-8400
Fax
(208) 734-3045
NPI assigned
Jun 4, 2006
Last updated
Mar 9, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2013

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

Authorized official

Name
Bruce C McComas, M.D.NPI 1235167198
Title
Physician
Phone
(208) 734-3596

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X M5070 ID Primary

Addresses

Primary practice location

775 Pole Line Rd W
Suite 212
Twin Falls, ID 83301-5814

Mailing address

PO Box 587
Twin Falls, ID 83303-0587
Phone (208) 814-7400

Other identifiers 2

IdentifierTypeStateIssuer
000369200MedicaidID
020048945OtherIDRR MEDICARE

Other names 1

  • Southern Idaho Vein Care Center Doing business as

National Provider Directory

National Provider Directory

Locations

775 Pole Line Rd W
Ste 212
Twin Falls, ID 83301
Phone (208) 814-8400

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362787200000",
    "number": "1407894041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 587",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833030587",
            "telephone_number": "208-814-7400",
            "fax_number": "208-814-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W",
            "address_2": "SUITE 212",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015814",
            "telephone_number": "208-814-8400",
            "fax_number": "208-734-3045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE C MCCOMAS, M. D., P. A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2013-03-09",
        "status": "A",
        "authorized_official_last_name": "MCCOMAS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "208-734-3596",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "ID",
            "license": "M5070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000369200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "020048945",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Idaho Vein Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 9, 2013; 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.