Dr Alexis E Shanahan, MD | |
190 E Bannock St, Boise, ID 83712-6241 | |
(208) 381-5015 | |
Not Available |
Full Name | Dr Alexis E Shanahan |
---|---|
Gender | Female |
Speciality | Hospitalist |
Experience | 19 Years |
Location | 190 E Bannock St, Boise, Idaho |
Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1376665471 | NPI | - | NPPES |
1376665471 | Medicaid | WY | |
1376665471 | Medicaid | ID | |
91081858 | Medicaid | NM | |
98175092 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 47626 (Colorado) | Secondary |
207R00000X | Internal Medicine | M11630 (Idaho) | Primary |
Facility Name | Location | Facility Type |
---|---|---|
St Luke's Regional Medical Center | Boise, ID | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
St Lukes Clinic-treasure Valley Llc | 4981878402 | 991 |
Entity Name | St Lukes Clinic-treasure Valley Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1326336058 PECOS PAC ID: 4981878402 Enrollment ID: O20111119000045 |
Mailing Address | Practice Location Address |
---|---|
Dr Alexis E Shanahan, MD 190 E Bannock St, Boise, ID 83712-6241 Ph: (208) 381-2222 | Dr Alexis E Shanahan, MD 190 E Bannock St, Boise, ID 83712-6241 Ph: (208) 381-5015 |
Dr. Jennifer A Hofstra, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 1055 N Curtis Road, Boise, ID 83706 Phone: 757-446-8920 Fax: 757-446-5242 | |
Dr. James Robert Polk, MD Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 1055 N Curtis Rd, Boise, ID 83706 Phone: 208-367-3104 | |
Dr. Michael Frederic Krug, M.D. Internal Medicine Medicare: Medicare Enrolled Practice Location: 190 E Bannock St, Boise, ID 83712 Phone: 208-381-5015 Fax: 208-381-1873 | |
Derrel V Walker, M.D. Internal Medicine Medicare: Medicare Enrolled Practice Location: 1055 N Curtis Road, Boise, ID 83706 Phone: 208-367-7350 Fax: 208-367-3951 | |
Dr. Janat E. O'donnell, MD Internal Medicine Medicare: Medicare Enrolled Practice Location: 500 W. Fort St., # 111, Boise, ID 83702 Phone: 208-422-1325 Fax: 208-422-1319 | |
Carl L Durning, MD Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 6094 W Emerald St, Boise, ID 83704 Phone: 208-367-6575 Fax: 208-367-6597 | |
Dr. Christopher J Goulet, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 6259 W Emerald St, Boise, ID 83704 Phone: 208-489-1900 Fax: 208-375-5286 |