| Digestive Health Clinic Llc | |
|
6259 W Emerald St Boise ID 83704-8731 | |
| (208) 489-1900 | |
| (208) 375-5286 |
| Full Name | Digestive Health Clinic Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6259 W Emerald St, Boise, Idaho |
| Authorized Official Name and Position | Mark A Mallory (MANAGER) |
| Authorized Official Contact | 2084891900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Digestive Health Clinic Llc 6259 W Emerald St Boise ID 83704-8731 Ph: (208) 489-1900 | Digestive Health Clinic Llc 6259 W Emerald St Boise ID 83704-8731 Ph: (208) 489-1900 |
| NPI Number | 1750498333 |
|---|---|
| Provider Enumeration Date | 08/23/2006 |
| Last Update Date | 07/24/2020 |
| Medicare PECOS PAC ID | 7315948874 |
|---|---|
| Medicare Enrollment ID | O20070125000398 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750498333 | NPI | - | NPPES |
| 807631700 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Christopher J Goulet |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1023085180 PECOS PAC ID: 3678500154 Enrollment ID: I20050726001119 |
| Provider Name | Stephen M Schutz |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1114994977 PECOS PAC ID: 9931100401 Enrollment ID: I20070126000296 |
| Provider Name | Mark A Mallory |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1336116888 PECOS PAC ID: 0840291316 Enrollment ID: I20070126000325 |
| Provider Name | Ike D Tanabe |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1184691602 PECOS PAC ID: 9931100492 Enrollment ID: I20070309000544 |
| Provider Name | Shauna T Williams |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1821150285 PECOS PAC ID: 4385720507 Enrollment ID: I20080327000451 |
| Provider Name | Joseph D Kronz |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1831135581 PECOS PAC ID: 0749224871 Enrollment ID: I20100707000496 |
| Provider Name | Valerie A Holst |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1861446064 PECOS PAC ID: 0941390918 Enrollment ID: I20100714000465 |
| Provider Name | Ashley T Evans |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1326238981 PECOS PAC ID: 0244471217 Enrollment ID: I20130802000636 |
| Provider Name | Nicholas G Grant |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1205096096 PECOS PAC ID: 3375784713 Enrollment ID: I20150716002997 |
| Provider Name | Meghan T Jankowski |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1518120179 PECOS PAC ID: 0547404725 Enrollment ID: I20150813012449 |
| Provider Name | Brian N Davis |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1164677944 PECOS PAC ID: 3173780368 Enrollment ID: I20150930002794 |
| Provider Name | Shannon Bordes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851831200 PECOS PAC ID: 7315217981 Enrollment ID: I20170714002031 |
| Provider Name | Bryan Basil Brimhall |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1902195753 PECOS PAC ID: 9133354228 Enrollment ID: I20190801003114 |
| Provider Name | Rebecca Osterkamp |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1548671092 PECOS PAC ID: 0840510830 Enrollment ID: I20200713002415 |
| Provider Name | Edward Krajicek |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1487060117 PECOS PAC ID: 2769608470 Enrollment ID: I20200713002522 |
| Provider Name | Joseph A Cook |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1700867199 PECOS PAC ID: 2668654419 Enrollment ID: I20200909000809 |
| Provider Name | Jeffrey Steven Bank |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1881089415 PECOS PAC ID: 5092097717 Enrollment ID: I20210721002057 |
| Provider Name | Victor Kp Chen |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1215916846 PECOS PAC ID: 7315958543 Enrollment ID: I20220907000160 |
| Provider Name | Troy Linnemeyer Carr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275250102 PECOS PAC ID: 5991160707 Enrollment ID: I20230501002217 |
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