| Dr Vipul N Nanavati, MD, BSME, CAQH | |
|
3381 W Bavaria St, Eagle, ID 83616-5341 | |
| (208) 639-4800 | |
| (208) 639-4801 |
| Full Name | Dr Vipul N Nanavati |
|---|---|
| Gender | Male |
| Speciality | Orthopaedic Surgery |
| Location | 3381 W Bavaria St, Eagle, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629074158 | NPI | - | NPPES |
| 1629074158 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207XS0106X | Orthopaedic Surgery - Hand Surgery | M-14885 (Idaho) | Secondary |
| 207X00000X | Orthopaedic Surgery | M-14885 (Idaho) | Primary |
| Entity Name | St Paul Place Specialists Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1871549196 PECOS PAC ID: 7719882943 Enrollment ID: O20031202000084 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Vipul N Nanavati, MD, BSME, CAQH 6590 W Norwood Dr, Boise, ID 83704-8765 Ph: (208) 506-3665 | Dr Vipul N Nanavati, MD, BSME, CAQH 3381 W Bavaria St, Eagle, ID 83616-5341 Ph: (208) 639-4800 |
Dr. Lisa R Rendon, M.D. Orthopedic Surgery Medicare: Not Enrolled in Medicare Practice Location: 3381 W Bavaria St, Eagle, ID 83616 Phone: 208-287-1110 Fax: 208-639-4801 | |
Dr. Joseph Gordon Daines, M.D. Orthopedic Surgery Medicare: Medicare Enrolled Practice Location: 766 W Colchester Dr, Eagle, ID 83616 Phone: 208-401-4790 | |
Dr. Carl Scott Humphrey, MD Orthopedic Surgery Medicare: May Accept Medicare Assignments Practice Location: 3381 W Bavaria Street, Eagle, ID 83616 Phone: 208-639-4800 Fax: 208-639-4801 |