Organization
EMERGENCY MEDICINE OF IDAHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN DAVID BISHOP (EXECUTIVE DIRECTOR)
(208) 615-8201
Entity
Organization
Contact information
Practice address
3080 E GENTRY WAY STE 210, MERIDIAN, ID 83642-3013
(208) 615-8201
(208) 779-2971
Mailing address
3080 E GENTRY WAY STE 210, MERIDIAN, ID 83642-3013
(208) 615-8201
(208) 779-2971
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010148698
REGENCE BLUE SHIELD IF ID
ID
05
—
807026800
—
ID
01
—
8K743
BLUE CROSS OF IDAHO
ID
Enumeration date
06/05/2006
Last updated
02/21/2025
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