| Blue Lakes Gastroenterology, Pllc | |
|
775 Pole Line Rd W Suite 203 Twin Falls ID 83301-5814 | |
| (208) 814-8300 | |
| (208) 733-8970 |
| Full Name | Blue Lakes Gastroenterology, Pllc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 775 Pole Line Rd W, Twin Falls, Idaho |
| Authorized Official Name and Position | Robert Ward (PHYSICIAN) |
| Authorized Official Contact | 2088148300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Lakes Gastroenterology, Pllc 775 Pole Line Rd W Suite 203 Twin Falls ID 83301-5814 Ph: (208) 814-8300 | Blue Lakes Gastroenterology, Pllc 775 Pole Line Rd W Suite 203 Twin Falls ID 83301-5814 Ph: (208) 814-8300 |
| NPI Number | 1144267022 |
|---|---|
| Provider Enumeration Date | 06/01/2006 |
| Last Update Date | 03/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144267022 | NPI | - | NPPES |
| 806237600 | Medicaid | ID | |
| CJ6218 | Other | ID | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | M6665 (Idaho) | Primary |
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