Gem State Pediatrics
Organization Active NPI Pediatrics Physician · Meridian, ID
NPI 1992853386 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1992853386
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- M5562 (ID)
- Legal business name
- GEM STATE PEDIATRICS
- Practice address
- 520 S Eagle Rd
Suite 1209
Meridian, ID 83642-6308 - Phone
- (208) 706-5460
- Fax
- (208) 706-5465
- NPI assigned
- Jan 8, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Mario Brus, MD
- Title
- Owner
- Phone
- (208) 706-5460
National Provider Directory
Locations
520 S Eagle Rd
Ste 1209
Meridian, ID 83642
Phone (208) 706-5460
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | M5562 | ID | Yes |
Addresses
Primary practice location
520 S Eagle Rd
Suite 1209
Meridian, ID 83642-6308
Mailing address
520 S Eagle Rd
Suite 1209
Meridian, ID 83642-6308
Phone (208) 706-5460
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 57885 | Other | ID | BLUE CROSS OF IDAHO |
| 000010001341 | Other | ID | BLUE SHIELD OF IDAHO |
Other providers in Meridian, ID
- Gem Prep: Meridian LLC
- Gem Prep: Meridian North LLC
- Gem Prep: Meridian South LLC
- Gem State Developmental Center LLC
- Gem State Developmental Center LLC
- Gem Transport LLC
- Gemstate Pharmacy Group Inc
- Gen State Integrative Medicine
- Amir Samir Zakhary Gendy
- Genesis Service Dogs Inc
All providers in Meridian, ID · Pediatrics Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.