| Ariel Shantay Avis Taysom, PA-C | |
|
220 Bannock St, Malad City, ID 83252-5068 | |
| (208) 766-2600 | |
| (208) 766-4258 |
| Full Name | Ariel Shantay Avis Taysom |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Experience | 6 Years |
| Location | 220 Bannock St, Malad City, Idaho |
| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609341098 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | PA-1656 (Idaho) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Portneuf Medical Center | Pocatello, ID | Hospital |
| Nell J Redfield Memorial Hospital | Malad, ID | Hospital |
| Mountain View Hospital | Idaho falls, ID | Hospital |
| Power County Hospital District | American falls, ID | Hospital |
| Bear Lake Memorial Hospital | Montpelier, ID | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Cardiovascular Specialists Of America Llc | 1557773934 | 5 |
| Mailing Address | Practice Location Address |
|---|---|
| Ariel Shantay Avis Taysom, PA-C 220 Bannock St, Malad City, ID 83252-5068 Ph: (208) 766-2600 | Ariel Shantay Avis Taysom, PA-C 220 Bannock St, Malad City, ID 83252-5068 Ph: (208) 766-2600 |
Rick C. Clark Jr., PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 220 Bannock St, Suite 306, Malad City, ID 83252 Phone: 208-766-2600 Fax: 208-766-4258 | |
Mel Bingham, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 220 Bannock St, Malad City, ID 83252 Phone: 208-766-2600 Fax: 208-766-4258 | |
Robert Todd Gillespie, P.A. Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 220 Bannock St, Suite B, Malad City, ID 83252 Phone: 208-766-2600 |