Idaho Diabetes & Endocrine Associates, Pa

LBN: Idaho Diabetes And Endocrine Associates, Pa
Idaho Diabetes & Endocrine Associates, Pa is an health care organization with primary practice located at 13909 W. Wainwright Drive , Boise ID 83713-1969. The organization recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism. Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism is the primary health care specialty. Idaho Diabetes And Endocrine Associates, Pa can be contacted via phone (208) 389-2213, or through Roosevelt, Theodore S via phone (208) 389-2213.

Contact Information

Primary practice address
13909 W. Wainwright Drive Boise ID 83713-1969
Phone: (208) 389-2213
Fax: (208) 389-4659
Website:
Map and Directions
Authorized official contact:
Name: Roosevelt, Theodore S MD, PHD, JD
Phone: (208) 389-2213

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X

Profile Details

NPI number 1790960961
LBN Legal business name Idaho Diabetes And Endocrine Associates, Pa
DBA Doing business as Idaho Diabetes & Endocrine Associates, Pa
Authorized official Roosevelt, Theodore S MD, PHD, JD
Entity Organization
Organization subpart 1 No
Enumeration date Jan 7th, 2008
Last updated May 18th, 2022 - about 3 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 1790960961 NPPES
Idaho Other 000010035381 REGENCE BLUE SHIELD OF ID
Idaho MEDICAID 002712100 REGENCE BLUE SHIELD OF ID
Idaho Other 77021 REGENCE BLUE SHIELD OF ID

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