CHUCK B FULLER (NPI# 1124015102) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124015102 |
| Entity Type | Individual |
| Full Name | CHUCK B FULLER |
| Credential | PA-C |
| Practice Address |
660 Shoshone St E Suite 130 Twin Falls ID 83301-6110 |
| Practice Telephone | 2087323400 |
| Practice Fax Number | 2087323300 |
| Mailing Telephone | 2087323400 |
| Mailing Fax Number | 2087323300 |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2008-01-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA-499 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | REGENCE BLUE SHIELD IND # | 000010147741 | 01 |
| ID | BLUE CROSS IND # | PAQR4 | 01 |
| Street Address |
660 SHOSHONE ST E SUITE 130 |
| City | TWIN FALLS |
| State | ID |
| Zip Code | 83301-6110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902840317 | Donald G Pica | Internal Medicine | 660 Shoshone St E, Suite 210, Twin Falls, ID 83301-6110 | 2006-06-15 |
| 1902847718 | Robert S Lobb | Internal Medicine | 660 Shoshone St E, Suite 130, Twin Falls, ID 83301-6110 | 2006-06-10 |
| 1265472781 | Warren F Dopson | Internal Medicine | 660 Shoshone St E, Suite 130, Twin Falls, ID 83301-6110 | 2006-06-07 |
| 1134169501 | Stanley Mogelson | Specialist | 660 Shoshone St E, Suite 110, Twin Falls, ID 83301-6110 | 2006-06-07 |
| 1245278746 | John L. Shuss, M.d., P.l.l.c. | Surgery | 660 Shoshone St E, Suite 140, Twin Falls, ID 83301-6110 | 2006-06-04 |
| 1730126566 | Snake River Urology, P.C. | Urology | 660 Shoshone St E, Suite 201, Twin Falls, ID 83301-6110 | 2006-06-01 |
| 1982641882 | Donald G Pica Md Pa | Internal Medicine | 660 Shoshone St E, Suite 210, Twin Falls, ID 83301-6110 | 2006-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023645918 | Matthew Anderson | Pharmacist | Dick's Pharmacy, 526 K Shoup Ave W, Twin Falls, ID 83301 | 2020-03-23 |
| 1780146316 | Frontier Pediatric Partners, Pllc | Pediatrics | 1502 Locust Street N #700, Twin Falls, ID 83301 | 2019-04-02 |
| 1972073377 | Wood River Acupuncture | Acupuncturist | 1625 Addison Ave East, Twin Falls, ID 83301 | 2018-11-28 |
| 1235629874 | Lonnie Paul | Counselor | 1092 Eastland Dr N Ste A, Twin Falls, ID 83301 | 2018-05-17 |
| 1679060966 | Christina Jirapha Thongdee | Social Worker | 625 Poleline Road West, Suite 2a, Twin Falls, ID 83301 | 2018-04-23 |
| 1437658499 | Tyrel Kevin Ward | Chiropractor | 2167 Village Park Ave., Suite 100, Twin Falls, ID 83301 | 2018-02-06 |
| 1851836381 | Tanabell Health Services, Inc | Skilled Nursing Facility | 1134 Cheney Drive West, Twin Falls, ID 83301 | 2016-12-19 |
| 1578005195 | Matthew Carter | Physical Therapist | 1053 Eastland Drive, Twin Falls, ID 83301 | 2016-11-14 |
| 1790227783 | Murvat Usmanova | Nurse Practitioner | 775 Pole Line Road W, Suite 203, Twin Falls, ID 83301 | 2016-11-08 |
| 1265894687 | Shawna Fultz | Social Worker | 1201 Fall Ave East Suite C, Twin Falls, ID 83301 | 2016-03-24 |
| Find all providers in zip 83301 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508355538 | Maurissa Radakovich | Physician Assistant | 775 Pole Line Rd W Ste 105, Twin Falls, ID 83301-5819 | 2018-05-04 |
| 1558730291 | Jacob Larsen | Physician Assistant | 775 Pole Line Rd W Ste 103, Twin Falls, ID 83301-5819 | 2015-09-23 |
| 1285794339 | South Central Public Health District | Physician Assistant | 1020 Washington St N, Twin Falls, ID 83301-3156 | 2006-12-11 |
| 1073547113 | John Laurent Etcheto | Physician Assistant | 176 Falls Avenue, Twin Falls, ID 83301 | 2006-07-11 |
| 1932166956 | Brian Keith Bizik | Physician Assistant | 800 Falls Avenue, Suite 2, Asthma & Alergy of Idaho, Twin Falls, ID 83301 | 2006-04-26 |
| 1356314843 | Jeremy David Willes | Physician Assistant | 260 Falls Ave, Suite C, Twin Falls, ID 83301-3370 | 2006-02-07 |
| 1588272116 | Kristina Jane Nye Bowden | Physician Assistant | 738 N College Rd Ste A, Twin Falls, ID 83301-3386 | 2020-07-20 |
| 1669004412 | Larry Hicks | Physician Assistant | 236 Martin St, Twin Falls, ID 83301-4542 | 2020-02-10 |
| 1790339273 | James Morris Roberts | Physician Assistant | 1502 Locust St N Ste 700, Twin Falls, ID 83301-4164 | 2019-08-01 |
| 1851805196 | Samantha Ruth Davis | Physician Assistant | 260 Falls Ave Ste C, Twin Falls, ID 83301-3370 | 2017-11-22 |
| Find all providers in TWIN FALLS | ||||
| City | TWIN FALLS |
| Zip Code | 83301 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.