| Gem State Ent, Pllc | |
|
2114 Village Park Ave # 200 Twin Falls ID 83301-4172 | |
| (208) 804-1717 | |
| (208) 804-1707 |
| Full Name | Gem State Ent, Pllc |
|---|---|
| Speciality | General Practice |
| Location | 2114 Village Park Ave # 200, Twin Falls, Idaho |
| Authorized Official Name and Position | Ashlyn Saari (MEDICAL CODER) |
| Authorized Official Contact | 2082437928 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gem State Ent, Pllc 2114 Village Park Ave # 200 Twin Falls ID 83301-4172 Ph: (208) 804-1717 | Gem State Ent, Pllc 2114 Village Park Ave # 200 Twin Falls ID 83301-4172 Ph: (208) 804-1717 |
| NPI Number | 1215715669 |
|---|---|
| Provider Enumeration Date | 09/18/2023 |
| Last Update Date | 09/18/2023 |
| Medicare PECOS PAC ID | 8123470481 |
|---|---|
| Medicare Enrollment ID | O20240123000730 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215715669 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Russell W Mayes |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1316162704 PECOS PAC ID: 8224196357 Enrollment ID: I20081018000142 |
| Provider Name | Kylan D Peterson |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1750542452 PECOS PAC ID: 6608061676 Enrollment ID: I20130802000550 |
| Provider Name | Charles B Larson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497120349 PECOS PAC ID: 6406154749 Enrollment ID: I20160419002907 |
| Provider Name | Robert Jensen |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1629424171 PECOS PAC ID: 8022302215 Enrollment ID: I20160810002949 |
| Provider Name | Robert E Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255970976 PECOS PAC ID: 3577990696 Enrollment ID: I20200302000966 |
| Provider Name | Skylar Muniz |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1710502281 PECOS PAC ID: 8325465917 Enrollment ID: I20200827001663 |
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