| Thomas Daniel Fife, PA-C | |
|
611 Clinic Rd, Challis, ID 83226 | |
| (208) 879-4351 | |
| (208) 879-5216 |
| Full Name | Thomas Daniel Fife |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Experience | 10 Years |
| Location | 611 Clinic Rd, Challis, 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 |
|---|---|---|---|
| 1689022519 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | PA-1371 (Idaho) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Idaho Falls Community Hospital, Llc | Idaho falls, ID | Hospital |
| Caribou Medical Center | Soda springs, ID | Hospital |
| Mountain View Hospital | Idaho falls, ID | Hospital |
| Eastern Idaho Regional Medical Center | Idaho falls, ID | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Caribou Medical Center, Inc | 7618365701 | 35 |
| Community Care West Side Llc | 3678738218 | 17 |
| Entity Name | Mountain View Hospital LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669462362 PECOS PAC ID: 4486562774 Enrollment ID: O20040527001343 |
| Entity Name | Community Care West Side LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1295009785 PECOS PAC ID: 3678738218 Enrollment ID: O20120703000554 |
| Entity Name | Idaho Falls Community Hospital LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1114481447 PECOS PAC ID: 9032441597 Enrollment ID: O20191217002564 |
| Entity Name | Caribou Medical Center, Inc |
|---|---|
| Entity Type | Part A Provider - Critical Access Hospital |
| Entity Identifiers | NPI Number: 1942970272 PECOS PAC ID: 7618365701 Enrollment ID: O20211021002404 |
| Entity Name | Emergency Physicians Integrated Care LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1578598199 PECOS PAC ID: 4284548116 Enrollment ID: O20220228001998 |
| Entity Name | Caribou Medical Center, Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1942970272 PECOS PAC ID: 7618365701 Enrollment ID: O20220314000619 |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas Daniel Fife, PA-C 611 Clinic Rd, Challis, ID 83226 Ph: (208) 879-4351 | Thomas Daniel Fife, PA-C 611 Clinic Rd, Challis, ID 83226 Ph: (208) 879-4351 |
Mr. Kenneth Henry Hyatt, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1 Clinic Road, Challis, ID 83226 Phone: 208-879-4351 Fax: 208-879-5216 |
Breeann Marie Petrie, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 431 E. Main St. #994, Challis, ID 83226 Phone: 208-833-1313 Fax: 833-839-1195 |
Mr. Matthew Chad Banks, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 611 Clinic Rd, Challis, ID 83226 Phone: 208-879-4351 Fax: 208-879-5216 |
Stephen Max Smith, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 611 Clinic Road, Challis, ID 83226 Phone: 208-879-4351 Fax: 208-879-5216 |
Ms. Grace Suyanti Muliawan, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 611 Clinic Rd, Challis, ID 83226 Phone: 208-879-4351 Fax: 208-879-5216 |
Miles Alan Haeberle, PHYSICIAN ASSISTANT Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 611 Clinic Rd, Challis, ID 83226 Phone: 208-879-4351 Fax: 208-879-5216 |
Joseph W Petrie, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 431 E. Main St., #994, Challis, ID 83226 Phone: 208-833-3773 Fax: 833-839-1175 |