| Idaho Gastroenterology Associates, Llp | |
|
425 W Bannock St Boise ID 83702-6035 | |
| (208) 343-1702 | |
| (208) 342-7042 |
| Full Name | Idaho Gastroenterology Associates, Llp |
|---|---|
| Speciality | Internal Medicine |
| Location | 425 W Bannock St, Boise, Idaho |
| Authorized Official Name and Position | Rebecca Butterfield (CREDENTIALING MANAGER) |
| Authorized Official Contact | 2084891431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Gastroenterology Associates, Llp 425 W Bannock St Boise ID 83702-6035 Ph: (208) 343-1702 | Idaho Gastroenterology Associates, Llp 425 W Bannock St Boise ID 83702-6035 Ph: (208) 343-1702 |
| NPI Number | 1265427256 |
|---|---|
| Provider Enumeration Date | 09/15/2005 |
| Last Update Date | 02/12/2024 |
| Medicare PECOS PAC ID | 6002708773 |
|---|---|
| Medicare Enrollment ID | O20040326001143 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265427256 | NPI | - | NPPES |
| 002799000 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Bonnie K Waite |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1770578759 PECOS PAC ID: 4981691110 Enrollment ID: I20040428001386 |
| Provider Name | Matthew R Sericati |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1194871871 PECOS PAC ID: 7810040862 Enrollment ID: I20090808000075 |
| Provider Name | Joseph D Kronz |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1831135581 PECOS PAC ID: 0749224871 Enrollment ID: I20100707000496 |
| Provider Name | Valerie A Holst |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1861446064 PECOS PAC ID: 0941390918 Enrollment ID: I20100714000465 |
| Provider Name | Christopher W Hammerle |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1740336361 PECOS PAC ID: 8527151083 Enrollment ID: I20120803000695 |
| Provider Name | Brian T Story |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1851551089 PECOS PAC ID: 9830330935 Enrollment ID: I20130801000681 |
| Provider Name | Akshay K Gupta |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1255542338 PECOS PAC ID: 4880745876 Enrollment ID: I20140102001395 |
| Provider Name | Nicholas G Grant |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1205096096 PECOS PAC ID: 3375784713 Enrollment ID: I20150716002997 |
| Provider Name | Jennifer Brown Leonard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649538463 PECOS PAC ID: 5496998676 Enrollment ID: I20150721000703 |
| Provider Name | Brian N Davis |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1164677944 PECOS PAC ID: 3173780368 Enrollment ID: I20150930002794 |
| Provider Name | Mark Joseph Dell'aglio |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1477656460 PECOS PAC ID: 2961599121 Enrollment ID: I20161201000867 |
| Provider Name | Robert Alanson Lockwood |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1588954101 PECOS PAC ID: 6406086248 Enrollment ID: I20180713002533 |
| Provider Name | Kirsten Joy Morigeau |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1811123961 PECOS PAC ID: 2062668874 Enrollment ID: I20180716002903 |
| Provider Name | Oswaldo Bisbal |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1487686242 PECOS PAC ID: 6901965847 Enrollment ID: I20181204002679 |
| Provider Name | Erin Marie Mccoy |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1700010873 PECOS PAC ID: 4486800505 Enrollment ID: I20200408001703 |
| Provider Name | Justin R Tomal |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1093129751 PECOS PAC ID: 3173836244 Enrollment ID: I20200617001933 |
| Provider Name | John Dever |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093918724 PECOS PAC ID: 1850432766 Enrollment ID: I20220701000654 |
| Provider Name | Edward Mark Hatrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982107736 PECOS PAC ID: 3577827914 Enrollment ID: I20220725000176 |
| Provider Name | Barry Jon Shinsel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144930801 PECOS PAC ID: 3577933423 Enrollment ID: I20230110002037 |
| Provider Name | Jeremy Gardner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902539976 PECOS PAC ID: 3971974767 Enrollment ID: I20230112002768 |
| Provider Name | Victoria Jaeger |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1770938318 PECOS PAC ID: 4789965666 Enrollment ID: I20230830001365 |
| Provider Name | Stephanie Dawn Maar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124540729 PECOS PAC ID: 5092076257 Enrollment ID: I20231114000579 |
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