Gardner & Gardner, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M6670 Issued in ID

Legal business name

GARDNER & GARDNER, PA

Doing business as

Cama Prairie Family Physicians

Practice address

203 N a St
Grangeville, ID 83530-1201

Phone

(208) 983-3000

Fax

(208) 983-9276

NPI assigned

Jul 11, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jim Gardner, MO

Title

President

Phone

(208) 983-3000

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Cama Prairie Family Physicians Doing business as

Locations

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477551794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 N A ST",
            "city": "GRANGEVILLE",
            "state": "ID",
            "postal_code": "835301201",
            "telephone_number": "208-983-3000",
            "fax_number": "208-983-9276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 N A ST",
            "city": "GRANGEVILLE",
            "state": "ID",
            "postal_code": "835301201",
            "telephone_number": "208-983-3000",
            "fax_number": "208-983-9276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDNER & GARDNER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-983-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M6671",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "NP416A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M6670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G02767400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cama Prairie Family Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Grangeville, ID
• Providers in Grangeville, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.