Derek Kohlhase, MD | |
10717 W State St, Star, ID 83669-6046 | |
(208) 302-6300 | |
(208) 302-6355 |
Full Name | Derek Kohlhase |
---|---|
Gender | Male |
Speciality | Family Medicine |
Location | 10717 W State St, Star, Idaho |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1407410830 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | MRM-1814 (Idaho) | Secondary |
207Q00000X | Family Medicine | M-15600 (Idaho) | Primary |
Entity Name | Saint Alphonsus Regional Medical Center Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1649357716 PECOS PAC ID: 3476462359 Enrollment ID: O20040204001036 |
Mailing Address | Practice Location Address |
---|---|
Derek Kohlhase, MD 3340 E Goldstone Dr, Meridian, ID 83642-1026 Ph: (208) 302-9342 | Derek Kohlhase, MD 10717 W State St, Star, ID 83669-6046 Ph: (208) 302-6300 |
Nathan R. Mason, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 10717 W State St, Star, ID 83669 Phone: 208-302-6300 Fax: 208-302-6355 | |
Dr. Thomas Richard Young Iii, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 4815 N High Country Way, Star, ID 83669 Phone: 208-761-6884 | |
Katherine Lea Mcdonough, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 10717 W State Street, Star, ID 83669 Phone: 208-302-6300 Fax: 208-302-6355 |