NPIMap

Organization Active NPI

Dermatology of Eastern Idaho PA

  • Specialist
  • Rigby, ID
National Provider Identifier
1548259161
Registry record updated Jun 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
M-6569 Issued in ID
Legal business name
DERMATOLOGY OF EASTERN IDAHO PA
Practice address
703 Rigby Lake Dr
Rigby, ID 83442-5192
Phone
(208) 745-0200
Fax
(208) 745-0212
NPI assigned
Oct 17, 2005
Last updated
Jun 30, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2010

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

Authorized official

Name
Kay Bishop, M.D.NPI 1699764209
Title
Owner
Phone
(208) 745-0200

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
Specialist 174400000X M-6569 ID Primary

Addresses

Primary practice location

703 Rigby Lake Dr
Rigby, ID 83442-5192

Mailing address

703 Rigby Lake Dr
Rigby, ID 83442-5192
Phone (208) 745-0200

Other identifiers 1

IdentifierTypeStateIssuer
806512200MedicaidID

National Provider Directory

National Provider Directory

Locations

703 Rigby Lake Dr
Rigby, ID 83442
Phone (208) 745-0200

Practitioners & affiliated clinicians

Practitioners 8

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": "1129507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277856000000",
    "number": "1548259161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 RIGBY LAKE DR",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425192",
            "telephone_number": "208-745-0200",
            "fax_number": "208-745-0212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 RIGBY LAKE DR",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425192",
            "telephone_number": "208-745-0200",
            "fax_number": "208-745-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY OF EASTERN IDAHO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-17",
        "last_updated": "2010-06-30",
        "status": "A",
        "authorized_official_last_name": "BISHOP",
        "authorized_official_first_name": "KAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-745-0200",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ID",
            "license": "M-6569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806512200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rigby, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; 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.