| Southeast Idaho Gastroenterology,pllc | |
|
1151 Hospital Way Bldg A Pocatello ID 83201-2763 | |
| (208) 232-6616 | |
| (208) 232-6618 |
| Full Name | Southeast Idaho Gastroenterology,pllc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 1151 Hospital Way Bldg A, Pocatello, Idaho |
| Authorized Official Name and Position | Darryl Bruce Cook (MEMBER) |
| Authorized Official Contact | 2082326616 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Idaho Gastroenterology,pllc Po Box 4788 Pocatello ID 83205-4788 Ph: (208) 232-6616 | Southeast Idaho Gastroenterology,pllc 1151 Hospital Way Bldg A Pocatello ID 83201-2763 Ph: (208) 232-6616 |
| NPI Number | 1295754265 |
|---|---|
| Provider Enumeration Date | 07/19/2006 |
| Last Update Date | 09/25/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295754265 | NPI | - | NPPES |
| 002803000 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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