Southwest Idaho Ear, Nose and Throat, PA

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

SOUTHWEST IDAHO EAR, NOSE AND THROAT, PA

Practice address

1000 State St
McCall, ID 83638-3704

Phone

(208) 367-3320

NPI assigned

Jun 12, 2006

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

Ryan Pharis

Title

Administrator

Phone

(208) 367-3320

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Southwest Idaho Ear, Nose and Throat

  • Otolaryngology Physician
  • Boise, ID
  • NPI 1306823125

  O20101008000695

  Same enrollment

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.

• Ryan Lewis Van de Graaff, MD

  • Otolaryngology Physician
  • Boise, ID
  • NPI 1619067436
  NPD

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801838180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N LIBERTY ST",
            "address_2": "STE 400",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 STATE ST",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836383704",
            "telephone_number": "208-367-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST IDAHO EAR, NOSE AND THROAT, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHARIS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-367-3320"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elynn E Smith, MD
• Mary T Smith, PHARMD
• Rachel L Smith, DPLAC
• Christy Diane Sofaly, LCSW
• Branette Bean Solace, N.M.D.
• St Luke's McCall LTD (St Luke's Payette Lakes Medical Clinic)
• St Lukes Clinic - McCall LLC (St Lukes Clinic - McCall)
• St Lukes McCall LTD
• St Lukes McCall LTD (St Lukes Payette Lakes Medical Clinic)
• St Lukes McCall, LTD

• Otolaryngology Physician in McCall, ID
• Providers in McCall, ID by specialty
• Otolaryngology 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.