Andrus, Carl Ryan

Andrus, Carl Ryan is an individual health care provider with primary practice located at 4902 W State St , Boise ID 83703-3326. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Andrus, Carl Ryan can be contacted via phone (208) 853-3100.

Contact Information

Primary practice address
4902 W State St Boise ID 83703-3326
Phone: (208) 853-3100
Fax: (208) 853-3120
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA-508 Idaho

Profile Details

NPI number 1215949532
LBN Legal business name Andrus, Carl Ryan
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 13th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215949532 NPPES
Idaho Other 000010157032 BLUE CROSS
Idaho MEDICAID 807520000 BLUE CROSS
Idaho Other PAD25 BLUE CROSS
Idaho Other 000010157033 BLUE CROSS
Idaho Other PAD26 BLUE CROSS

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