Burn and Reconstructive Centers of Idaho, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

BURN AND RECONSTRUCTIVE CENTERS OF IDAHO, PLLC

Practice address

3100 Channing Way
Idaho Falls, ID 83404-7533

Phone

(706) 863-9595

Fax

(706) 868-8375

NPI assigned

Jan 28, 2019

Organization subpart

No

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

Authorized official

Name

Shawn FaganNPI 1265448500

Title

Owner/MD

Phone

(706) 863-9595

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shawn P Fagan, M.D.

  • Surgery Physician
  • Augusta, GA
  • NPI 1265448500
  NPD (past) Authorized official
• Claus Brandigi, M.D.

  • Surgery Physician
  • Fort Lauderdale, FL
  • NPI 1821065525
  NPD (past)

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

{
    "created_epoch": "1548633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665446400000",
    "number": "1902360639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12358",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309142358",
            "telephone_number": "706-863-9595",
            "fax_number": "706-868-8375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047533",
            "telephone_number": "706-863-9595",
            "fax_number": "706-868-8375"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7700 Floyd Curl Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782293902",
            "country_code": "US",
            "telephone_number": "706-863-9595",
            "fax_number": "706-868-8375",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2325 Coronado St",
            "address_purpose": "LOCATION",
            "city": "Idaho Falls",
            "state": "ID",
            "postal_code": "834047407",
            "country_code": "US",
            "telephone_number": "706-863-9595",
            "fax_number": "706-868-8375",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3200 Channing Way Ste 206A&b",
            "address_purpose": "LOCATION",
            "city": "Idaho Falls",
            "state": "ID",
            "postal_code": "834047546",
            "country_code": "US",
            "telephone_number": "706-863-9595",
            "fax_number": "706-868-8375",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3901 W 15th St",
            "address_purpose": "LOCATION",
            "city": "Plano",
            "state": "TX",
            "postal_code": "750757738",
            "country_code": "US",
            "telephone_number": "706-863-9595",
            "fax_number": "706-868-8375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BURN AND RECONSTRUCTIVE CENTERS OF IDAHO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-28",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "706-863-9595"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Marie Burger, ACAGNP-C
• Terrell Burgess, BA
• Burke Family Chiropractic Integrative Health Services, Inc.
• Terry Lynn Burke, D.C., N.M.D.
• Tyler Burke, DPT
• Robert Stephen Burns, LMT
• Neil K Burraston, DO
• Bryce A. Burtenshaw, DDS
• Kathryn Burton, PHARMD
• Ryan Kent Busby

• Specialist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; 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.