NPIMap

Organization Active NPI

Valley Facial Plastics & ENT, PA

  • Otolaryngology Physician
  • Lewiston, ID
National Provider Identifier
1952441024
Registry record updated Jul 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
VALLEY FACIAL PLASTICS & ENT, PA
Practice address
330 Warner Dr
Lewiston, ID 83501-4441
Phone
(208) 746-0193
Fax
(208) 746-7074
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2025

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

Authorized official

Name
Jeff Burry, DO
Title
President
Phone
(208) 746-0193

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

330 Warner Dr
Lewiston, ID 83501-4441

Mailing address

330 Warner Dr
Lewiston, ID 83501-4441
Phone (208) 746-0193

Other identifiers 2

IdentifierTypeStateIssuer
002456000MedicaidID
7092091MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031216000072 WA Part B Supplier - Clinic/Group Practice 0840197166 Receives reassigned benefits from 2 practitioners
Practice locations: Clarkston, WA; Pullman, WA
O20040806001184 ID Part B Supplier - Clinic/Group Practice 0840197166 Receives reassigned benefits from 3 practitioners
Practice locations: Lewiston, ID; Moscow, ID

National Provider Directory

National Provider Directory

Locations

330 Warner Dr
Lewiston, ID 83501
Phone (208) 746-0193

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752796800000",
    "number": "1952441024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 WARNER DR",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014441",
            "telephone_number": "208-746-0193",
            "fax_number": "208-746-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 WARNER DR",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014441",
            "telephone_number": "208-746-0193",
            "fax_number": "208-746-7074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY FACIAL PLASTICS & ENT, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A",
        "authorized_official_last_name": "BURRY",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-746-0193",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002456000",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7092091",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; 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.