Eric Allen, MD
Individual provider Active NPI Pediatrics Physician · Twin Falls, ID
NPI 1508494071 · NPPES record last updated Aug 7, 2023
Key facts
- NPI
- 1508494071
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- M-17366 (ID)
- Practice address
- 2550 Addison Ave E Ste Abandf
Twin Falls, ID 83301-6767 - Phone
- (208) 814-8000
- NPI assigned
- Mar 31, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230821001395 | ID | Practitioner - Pediatric Medicine | 3375905557 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Luke'S Clinic LLC | Pediatrics | Current |
Accepting new patients |
| St Luke'S Magic Valley Regional Medical Center LTD | Past | Accepting new patients |
Locations
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
2550 Addison Ave E
Ste B
Twin Falls, ID 83301
Phone (208) 514-2505
775 Pole Line Rd W
Ste 111
Twin Falls, ID 83301
2550 Addison Ave E
Ste Abandf
Twin Falls, ID 83301
2550 Addison Ave E
Ste A
Twin Falls, ID 83301
Phone (208) 814-7700
746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | M-17366 | ID | Yes |
Addresses
Primary practice location
2550 Addison Ave E Ste Abandf
Twin Falls, ID 83301-6767
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Other practice location 1
Loma Linda University Health Pediatrics, General
11234 Anderson Street
Loma Linda, CA 92354
Phone (909) 558-4174
Other providers in Twin Falls, ID
- Richard E. Alexander
- All About You Hormones and Wellness, PLLC
- Marc Allan
- Scott E. Allan
- David C Allen
- Janice Allen
- Jaylene Allen
- Julie D. Allen
- Kimberly Rae Allen
- Laura Leigh Allen
All providers in Twin Falls, ID · Pediatrics Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.