Southeast Idaho Gastroenterology, PLLC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-629 Issued in ID

Legal business name

SOUTHEAST IDAHO GASTROENTEROLOGY, PLLC

Practice address

1151 Hospital Way Ste a
Pocatello, ID 83201-5091

Phone

(208) 232-6616

Fax

(208) 232-6618

NPI assigned

Dec 17, 2007

Last updated

Dec 17, 2007By 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

Debbie J Ferrel

Title

Practice Manager

Phone

(208) 232-6616

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197849600000",
    "number": "1780867457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 HOSPITAL WAY STE A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015091",
            "telephone_number": "208-232-6616",
            "fax_number": "208-232-6618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 HOSPITAL WAY STE A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015091",
            "telephone_number": "208-232-6616",
            "fax_number": "208-232-6618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST IDAHO GASTROENTEROLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2007-12-17",
        "status": "A",
        "authorized_official_last_name": "FERREL",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "208-232-6616"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806196200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Park, Inc.
• South Park, Inc. (Developmental Options)
• South Park, Inc. (Developmental Options)
• South Park, Inc. (Developmental Options)
• Southeast Idaho Council of Governments
• Southeast Idaho Gastroenterology,PLLC
• Southeast Idaho Orthodontics, PLLC
• Southeastern District Health Department
• Southeastern District Health Department (Southeastern Idaho Public Health)
• Southeastern District Health Dept.

• Medical Physician Assistant in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; 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.