ROCKY MOUNTAIN EMERGENCY PHYSICIANS, LLC (NPI# 1508003104) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508003104 |
| Entity Type | Organization |
| Organization Name | ROCKY MOUNTAIN EMERGENCY PHYSICIANS, LLC |
| Practice Address |
777 Hospital Way Pocatello ID 83201 |
| Mailing Address |
Po Box 15070 Scottsdale AZ 85267-5070 |
| Practice Telephone | 4804219799 |
| Practice Fax Number | 4804219899 |
| Mailing Telephone | 4804219700 |
| Mailing Fax Number | 4804219899 |
| Enumeration Date | 2009-01-19 |
| Last Update Date | 2011-05-11 |
| Authorized Official Name | DR. RANDALL SCOTT FOWLER (PRESIDENT) |
| Authorized Official Telephone | 2082391111 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
M4363 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | LICNESE NUMBER | M4363 | 01 |
| ID | BLUE CROSS | 8N801 | 01 |
| Street Address |
777 HOSPITAL WAY |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104825892 | Gregory S Harrison | Neurological Surgery | 777 Hospital Way, Suite 115, Pocatello, ID 83201-5175 | 2005-07-15 |
| 1801401344 | Sunny Blue Alene Nelson | Physician Assistant | 777 Hospital Way, Pocatello, ID 83201-5175 | 2020-09-11 |
| 1316570757 | Mark Alan Pendleton | Nurse Anesthetist, Certified Registered | 777 Hospital Way, Pocatello, ID 83201-5175 | 2020-02-13 |
| 1508413220 | Hilary Worthen | Specialist/Technologist | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-08-19 |
| 1437612447 | Walter S Medlin Md PC | Surgery | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-04-08 |
| 1396203428 | Amber Frost | Family Medicine | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-03-07 |
| 1649756404 | Kamilla Gundersen | Nurse Practitioner | 777 Hospital Way, Pocatello, ID 83207 | 2018-07-16 |
| 1043716285 | Brice Anderson | Specialist/Technologist | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-04-05 |
| 1851808133 | Rocky Mountain Physician Group LLC | Emergency Medicine | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-01-08 |
| 1154838886 | Mark Willis | Nurse Practitioner | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-01-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538516471 | Anthony Christopher Derrico | Emergency Medicine | 366 Gunfighter Ave Ste 498, Mountain Home Afb, ID 83648-5258 | 2016-05-20 |
| 1881752913 | Richard K Thurston | Emergency Medicine | 229 S 7th Street, St Maries, ID 83861 | 2006-12-04 |
| 1255399820 | Warren William Gude | Emergency Medicine | 600 Robbins Road, The Center for Wound Healing and Hyperbaric Medicine, Boise, ID 83702 | 2006-05-03 |
| 1821529918 | Jonathan Subaitani | Emergency Medicine | 11197 W Fairview Ave, Boise, ID 83713 | 2017-03-21 |
| 1841679669 | Robert John Hagenberg IIi | Emergency Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642 | 2015-05-26 |
| 1194019406 | Michael Anderson | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2011-06-03 |
| 1225201148 | Rodney Gillman Jay Jr. | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2008-04-11 |
| 1720114275 | North Idaho Immediate Care | Emergency Medicine | 750 N Syringa St, Suite 100, Post Falls, ID 83854-5275 | 2007-02-26 |
| 1407903669 | Debra K Mckinnon | Emergency Medicine | 700 S Main St, Moscow, ID 83843-3056 | 2007-01-03 |
| 1710034988 | Kurt R Martyn | Emergency Medicine | 700 S Main St, Moscow, ID 83843-3056 | 2007-01-03 |
| Find all providers with the same taxonomy | ||||
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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.