Ada Dermatology, P.A.

LBN: Ada Dermatology, P.A.
Ada Dermatology, P.A. is an health care organization with primary practice located at 6454 W Emerald Street , Boise ID 83704-8734. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Procedural Dermatology, which is considered as the primary health care specialty. Ada Dermatology, P.A. can be contacted via phone (208) 377-0820, or through Blickenstaff, Richard Dale via phone (208) 377-0820.

Contact Information

Primary practice address
6454 W Emerald Street Boise ID 83704-8734
Phone: (208) 377-0820
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Blickenstaff, Richard Dale Doctor of Medicine (MD)
Phone: (208) 377-0820

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Procedural Dermatology 207NS0135X M-5274 Idaho

Profile Details

NPI number 1952483299
LBN Legal business name Ada Dermatology, P.A.
DBA Doing business as
Authorized official Blickenstaff, Richard Dale Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Oct 19th, 2006
Last updated Jan 30th, 2012 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952483299 NPPES
Idaho MEDICAID 002639100

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