Gregory Mathew Wickern (NPI# 1972578672, PAC ID# 1759472244) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is ALLERGY/IMMUNOLOGY.
| Nation Provider ID (NPI) | 1972578672 |
| PAC ID by PECOS | 1759472244 |
| Professional Enrollment ID | I20090618000502 |
| Full Name | Gregory Mathew Wickern |
| Organization Legal Name | ASTHMA AND ALLERGY OF IDAHO PLLC |
| Address |
800 Falls Ave Suite 2 Twin Falls ID 83301-3366 |
| Phone Number | 2087346091 |
| Gender | M |
| Medical School | UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES |
| Graduation Year | 1985 |
| Primary Specialty | ALLERGY/IMMUNOLOGY |
| Secondary Specialties | PEDIATRIC MEDICINE |
| Group Practice PAC ID | 7416943782 |
| Number of Group Practice Members | 7 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 130002 | ST LUKES MAGIC VALLEY MEDICAL CENTER |
| 131302 | NORTH CANYON MEDICAL CENTER |
| 131319 | MINIDOKA MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 1263 Bennett Ave, Suite 3, Burley, ID 83318-4906 | 2086781049 | ASTHMA AND ALLERGY OF IDAHO PLLC |
| 1250 Lamoille Hwy, Suite 624, Elko, NV 89801-8308 | 7757533945 | ASTHMA AND ALLERGY OF IDAHO PLLC |
| 408 S Main St, Hailey, ID 83333-8402 | 2087881886 | ASTHMA AND ALLERGY OF IDAHO PLLC |
| 800 Falls Ave, Suite 2, Twin Falls, ID 83301-3366 | 2087346091 | ASTHMA AND ALLERGY OF IDAHO PLLC |
| Organization Legal Name | ASTHMA AND ALLERGY OF IDAHO PLLC |
| Physicians | 7 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Clark Joseph Wyatt | Nurse Practitioner | Asthma and Allergy of Idaho Pllc | 800 Falls Ave, Suite 2, Twin Falls, ID 83301-3366 |
| Shari V Montandon | Allergy/immunology | Asthma and Allergy of Idaho Pllc | 714 W Appleway Ave, Suite 200, Coeur D Alene, ID 83814-9330 |
| Richard E Henry | Allergy/immunology | Asthma and Allergy of Idaho Pllc | 1250 Lamoille Hwy, Suite 624, Elko, NV 89801-8308 |
| Kenneth J. Wakefield | Allergy/immunology | Asthma and Allergy of Idaho Pllc | 800 Falls Ave, Suite 2, Twin Falls, ID 83301-3366 |
| Ashley Ann Stroud | Nurse Practitioner | Asthma and Allergy of Idaho Pllc | 714 W Appleway Ave, Suite 200, Coeur D Alene, ID 83814-9330 |
| Jennifer A Watson | Nurse Practitioner | Asthma and Allergy of Idaho Pllc | 714 W Appleway Ave, Suite 200, Coeur D Alene, ID 83814-9330 |
| Street Address |
800 FALLS AVE SUITE 2 |
| City | TWIN FALLS |
| State | ID |
| Zip | 83301-3366 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Clark Joseph Wyatt | Nurse Practitioner | Asthma and Allergy of Idaho Pllc | 800 Falls Ave, Suite 2, Twin Falls, ID 83301-3366 |
| Kenneth J. Wakefield | Allergy/immunology | Asthma and Allergy of Idaho Pllc | 800 Falls Ave, Suite 2, Twin Falls, ID 83301-3366 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| John L Etcheto | Physician Assistant | Southern Idaho Pain Institute P.C. | 176 Falls Ave, Twin Falls, ID 83301-2306 |
| Daniel M Wettstein | Podiatry | 176 Falls Ave, Suite 200, Twin Falls, ID 83301-2306 | |
| Clinton L Dille | Anesthesiology | Southern Idaho Pain Institute P.C. | 176 Falls Ave, Twin Falls, ID 83301-2306 |
| Benjamin W Attebury | Physician Assistant | Southern Idaho Pain Institute P.C. | 176 Falls Ave, Twin Falls, ID 83301-2306 |
| Johnny M Urrutia | Physician Assistant | Southern Idaho Pain Institute P.C. | 176 Falls Ave, Twin Falls, ID 83301-2306 |
| Ronald E Mcgarrigle | Anesthesiology | St Luke's Clinic LLC | 450 Falls Ave, Suite 202, Twin Falls, ID 83301-2307 |
| Tammy L Emerson | Qualified Speech Language Pathologist | 450 Falls Ave, Twin Falls, ID 83301-2307 | |
| Todd G Hastings | Preventative Medicine | St Luke's Clinic LLC | 450 Falls Ave, Suite 202, Twin Falls, ID 83301-2307 |
| Thomas W Dirocco | Hospitalist | St Luke's Clinic LLC | 450 Falls Ave, Suite 202, Twin Falls, ID 83301-2307 |
| Mark J Edlund | Psychiatry | St Luke's Clinic LLC | 450 Falls Ave, Suite 202, Twin Falls, ID 83301-2307 |
| Find all physicians in zip 83301 | |||
| City | TWIN FALLS |
| Zip Code | 83301 |
| Specialty | ALLERGY/IMMUNOLOGY |
| City + Specialty | TWIN FALLS + ALLERGY/IMMUNOLOGY |
Please comment or provide details below to improve the information on Gregory Mathew Wickern.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.