Blue Lakes Gastroenterology, Pllc

LBN: Blue Lakes Gastroenterology, Pllc
Blue Lakes Gastroenterology, Pllc is an health care organization with primary practice located at 775 Pole Line Rd W Suite 203, Twin Falls ID 83301-5814. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as the primary health care specialty. Blue Lakes Gastroenterology, Pllc can be contacted via phone (208) 814-8300, or through Ward, Robert via phone (208) 814-8300.

Contact Information

Primary practice address
775 Pole Line Rd W Suite 203 Twin Falls ID 83301-5814
Phone: (208) 814-8300
Fax: (208) 733-8970
Website:
Map and Directions
Authorized official contact:
Name: Ward, Robert Doctor of Medicine (MD)
Phone: (208) 814-8300

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X M6665 Idaho

Profile Details

NPI number 1144267022
LBN Legal business name Blue Lakes Gastroenterology, Pllc
DBA Doing business as
Authorized official Ward, Robert Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jun 1st, 2006
Last updated Mar 9th, 2013 - 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 1144267022 NPPES
Idaho MEDICAID 806237600
Idaho Other CJ6218

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