GEM STATE RADIOLOGY LLP (NPI# 1124258611) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124258611 |
| Entity Type | Organization |
| Organization Name | GEM STATE RADIOLOGY LLP |
| Other Organization Name | ADVANCED VEIN THERAPY |
| Practice Address |
161 E Mallard Dr Suite 130 Boise ID 83706-5015 |
| Mailing Address |
877 W Main St Suite 603 Boise ID 83702-5883 |
| Practice Telephone | 2089470100 |
| Practice Fax Number | 2086396625 |
| Mailing Telephone | 2083849060 |
| Mailing Fax Number | 2083849023 |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2009-07-30 |
| Authorized Official Name | MR. JEFFREY R. CLIFF (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2083849060 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085U0001X |
Radiology Specialization: Diagnostic Ultrasound |
Allopathic & Osteopathic Physicians | ||
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 805368800 | 05 |
| Other Name | Type Code |
|---|---|
| Advanced Vein Therapy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154584712 | Gem State Radiology LLP | Radiology | 161 E Mallard Dr, Suite 130, Boise, ID 83706-3974 | 2008-07-03 |
| 1083661508 | Gem State Radiology LLP | Radiology | 1055 N Curtis Rd, Boise, ID 83706-1352 | 2006-05-29 |
| Street Address |
161 E MALLARD DR SUITE 130 |
| City | BOISE |
| State | ID |
| Zip Code | 83706-5015 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679513303 | Intermountain Medical Imaging LLC | Radiology | 161 E Mallard Dr, Suite 120, Boise, ID 83706-5015 | 2006-06-08 |
| 1891313664 | Aimee Edwards Gaedecke | Counselor | 161 E Mallard Dr, Boise, ID 83706-5015 | 2020-07-08 |
| 1518291491 | Shawna Marie Beechinor | Physician Assistant | 161 E Mallard Dr, Suite 130, Boise, ID 83706-5015 | 2009-09-25 |
| 1154584712 | Gem State Radiology LLP | Radiology | 161 E Mallard Dr, Suite 130, Boise, ID 83706-3974 | 2008-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164993010 | Brette Marie Stephenson | Counselor | 1529 Belmont St., Boise, ID 83706 | 2018-12-17 |
| 1295249241 | Boise of Cascadia, LLC | Skilled Nursing Facility | 6000 W. Denton St., Boise, ID 83706 | 2017-11-29 |
| 1174035638 | Zacharia Njoroge | Physician Assistant | 1055 N Curtis Rd 6th Floor, Boise, ID 83706 | 2017-10-24 |
| 1740708965 | Total Renal Care Inc | Clinic/Center | 1070 N Curtis Rd Ste 125, Boise, ID 83706 | 2017-09-08 |
| 1023532173 | Amber Frisch | Massage Therapist | 2509 S Gekeler Lane, Boise, ID 83706 | 2017-07-31 |
| 1952768145 | Katie Garcin | Specialist | 1407 E Boston Dr, Boise, ID 83706 | 2016-01-20 |
| 1770950677 | Kathryn Bender | Counselor | 1205 N Garden St, Boise, ID 83706 | 2015-08-26 |
| 1457751802 | Sabrina Shumar | Physician Assistant | 901 N Curtis Rd Ste 501, Boise, ID 83706 | 2014-09-03 |
| 1831525070 | Katie Joy Wilson | Social Worker | 333 W. Rossi St. #300, Boise, ID 83706 | 2013-09-19 |
| 1609208610 | Christine Lea Eden | Surgery | 1075 N Curtis Rd Ste 101, Boise, ID 83706 | 2013-07-31 |
| Find all providers in zip 83706 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598726960 | Christopher M Alessi | Surgery | 6140 W Curtisian Ave Ste 400, Boise, ID 83704-8907 | 2006-03-28 |
| 1033608161 | Alessi Vascular Surgery PC | Surgery | 6140 W Curtisian Ave Ste 400, Boise, ID 83704-8907 | 2018-05-03 |
| 1043527286 | Graham W Donald | Surgery | 6140 W Curtisian Ave, Ste 102, Boise, ID 83704 | 2010-09-09 |
| 1659699841 | St Luke's Regional Medical Center | Surgery | 333 N 1st St, Ste 280, Boise, ID 83702-6100 | 2010-05-12 |
| 1790738516 | Jeffery J. Gilbertson | Surgery | 333 N 1st St, Suite 280, Boise, ID 83702-6100 | 2006-05-19 |
| 1104878446 | Philippe A. Masser | Surgery | 333 N 1st St, Suite 280, Boise, ID 83702-6100 | 2006-05-16 |
| 1609828003 | Brian D Matteson | Surgery | 333 N 1st St, #280, Boise, ID 83702-6100 | 2006-05-16 |
| 1154370328 | Jeffrey B. Symmonds | Surgery | 6140 W Curtisian, Suite 300, Boise, ID 83704 | 2006-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770529240 | Wes Jon Arlein | Surgery | 700 W Ironwood Dr Ste 350, Coeur D Alene, ID 83814 | 2006-06-21 |
| 1598717985 | Michael J. Tullis | Surgery | 3875 E Overland Rd Ste 2d, Meridian, ID 83642-9005 | 2006-05-16 |
| 1598767196 | Douglas R Stafford | Surgery | 2109 N Main St, Coeur D Alene, ID 83814 | 2005-08-12 |
| 1164426771 | Gregory R. Hodson | Surgery | 2225 Teton Plz, Ste B, Idaho Falls, ID 83404-6494 | 2005-06-10 |
| 1609346303 | Superior Vein Care, Pllp | Surgery | 3875 E Overland Rd Ste 2d, Meridian, ID 83642-9005 | 2018-11-26 |
| 1043322811 | Laser and Vein Center Pllc | Surgery | 608 Northwest Blvd, Suite 301, Coeur D Alene, ID 83814-2174 | 2006-08-31 |
| 1922035104 | David A Johnson | Surgery | 775 Pole Line Rd W, Suite 213, Twin Falls, ID 83301-5814 | 2006-06-26 |
| 1841234069 | Venia, Pllc | Surgery | 2109 N Main St, Coeur D Alene, ID 83814-5768 | 2006-06-16 |
| 1467499418 | David Johnson, M.d., P. A. | Surgery | 775 Pole Line Rd W, Suite 213, Twin Falls, ID 83301-5814 | 2006-05-31 |
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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.