| Tyler Roe, DO | |
|
1344 Hiland Ave Ste A, Burley, ID 83318 | |
| (208) 678-7246 | |
| Not Available |
| Full Name | Tyler Roe |
|---|---|
| Gender | Male |
| Speciality | Pain Management |
| Experience | 12 Years |
| Location | 1344 Hiland Ave Ste A, Burley, Idaho |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710305768 | NPI | - | NPPES |
| 388203701 | Medicaid | TX | |
| 388203702 | Other | TX | CSHCN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207L00000X | Anesthesiology | Q8621 (Texas) | Secondary |
| 207LP2900X | Anesthesiology - Pain Medicine | O-1201 (Idaho) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Cassia Regional Hospital | Burley, ID | Hospital |
| Minidoka Memorial Hospital | Rupert, ID | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Sipi Clinic Llc | 5890167233 | 6 |
| Magic Valley Pain Specialists, Pllc | 8820484389 | 2 |
| Entity Name | Minidoka Memorial Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1134333495 PECOS PAC ID: 7315908894 Enrollment ID: O20041019001205 |
| Entity Name | Minidoka Memorial Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1679553531 PECOS PAC ID: 7315908894 Enrollment ID: O20050801000086 |
| Entity Name | North Canyon Medical Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1609046671 PECOS PAC ID: 0941371439 Enrollment ID: O20090409000304 |
| Entity Name | Sipi Ambulatory Surgery Center |
|---|---|
| Entity Type | Part B Supplier - Ambulatory Surgical Center |
| Entity Identifiers | NPI Number: 1518272087 PECOS PAC ID: 8426240664 Enrollment ID: O20101006001183 |
| Entity Name | Pain & Spine Consultants |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1902366834 PECOS PAC ID: 5395072946 Enrollment ID: O20190806001323 |
| Entity Name | Magic Valley Pain Specialists, Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1003564998 PECOS PAC ID: 8820484389 Enrollment ID: O20220408001697 |
| Entity Name | Sipi Clinic Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780398586 PECOS PAC ID: 5890167233 Enrollment ID: O20230210000802 |
| Mailing Address | Practice Location Address |
|---|---|
| Tyler Roe, DO 1344 Hiland Ave Ste A, Burley, ID 83318-1564 Ph: (208) 678-7246 | Tyler Roe, DO 1344 Hiland Ave Ste A, Burley, ID 83318 Ph: (208) 678-7246 |