Blue Lakes Gastroenterology PLLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

BLUE LAKES GASTROENTEROLOGY PLLC

Practice address

775 Pole Line Rd W
Suite 203
Twin Falls, ID 83301-5814

Phone

(208) 814-8300

Fax

(208) 733-8970

NPI assigned

May 30, 2007

Last updated

Mar 9, 2013By 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

Robert Ward, M.D.NPI 1508894262

Title

Physician

Phone

(208) 814-8300

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Robert M Ward Jr., M.D.

  • Gastroenterology Physician
  • Twin Falls, ID
  • NPI 1508894262
  Authorized official Same address or phone

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362787200000",
    "number": "1821299553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W",
            "address_2": "SUITE 203",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015814",
            "telephone_number": "208-814-8300",
            "fax_number": "208-733-8970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W",
            "address_2": "SUITE 203",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015814",
            "telephone_number": "208-814-8300",
            "fax_number": "208-733-8970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE LAKES GASTROENTEROLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2013-03-09",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "208-814-8300",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807132400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandria Malvina Blincoe, RN, BSN
• Bloom Therapy LLC
• Becky L Bloxham I, LSW
• Blue Lakes Anesthesia
• Blue Lakes Chiropractic, PA
• Blue Lakes Gastroenterology, PLLC
• Blue Lakes Medicine PA
• Bluebird Bio-Consulting, LLC
• Body & Mind Wellness LLC
• Bodybalance PT Twin Falls LLC (BodyBalance Physical Therapy)

• Nurse Practitioner in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2013; 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.