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DERMATOLOGY OF EASTERN IDAHO PA
NPI 1548259161
Specialist in Rigby, ID

Active since October 17, 2005
703 RIGBY LAKE DR, RIGBY, ID 83442(208) 745-0200(208) 745-0212 Get Directions Write a Review

NPPES record last updated: June 30, 2010. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dermatology Of Eastern Idaho Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DERMATOLOGY OF EASTERN IDAHO PA (NPI 1548259161) is a healthcare organization registered as a specialist in Rigby, Idaho and active in the NPI registry since October 2005. The organization lists Kay Bishop, Owner, as its authorized official.

NPPES Registry Identity

NPI1548259161
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameDERMATOLOGY OF EASTERN IDAHO PA
Location Address703 RIGBY LAKE DRRigby, ID 83442-5192
Mailing Address703 Rigby Lake DrRigby, ID 83442-5192 · (208) 745-0200 · Fax (208) 745-0212
Phone(208) 745-0200
Fax(208) 745-0212
Organization SubpartNo
Authorized OfficialKay BishopOwner · (208) 745-0200
Enumeration DateOctober 17, 2005
Last NPPES UpdateJune 30, 2010
✔ NPI 1548259161 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in ID · M-6569
Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

703 RIGBY LAKE DR, Rigby, ID 83442
Open in Google Maps ↗

Other Identifiers 2

Medicare PIN1373992
Medicaid806512200ID

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 13D0917694

High Valley Dermatology And Dermatologic Surgery PLLC · Rigby, ID
Expired · Apr 6, 2026
CLIA Number13D0917694
Laboratory TypePhysician Office
Certificate Effective DateApril 7, 2024
Certificate Expiration DateApril 6, 2026
Laboratory DirectorBrandon L. Miner
Laboratory Phone(208) 525-4888
Laboratory LocationHigh Valley Dermatology And Dermatologic Surgery PLLC703 Rigby Lake Dr, Rigby, ID 83442
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KAY BISHOP M.D.
Specialist
703 RIGBY LAKE DR
RIGBY, ID 83442
Jefferson County (208) 745-0200
MR. CAMERON T. FRENCH PA-C
Physician Assistant (Medical)
703 RIGBY LAKE DR
RIGBY, ID 83442
Jefferson County (208) 745-0200
MR. QUINN DONALD RANSON PA-C
Physician Assistant
703 RIGBY LAKE DR
RIGBY, ID 83442
Jefferson County (208) 745-0200
RYAN BLACK PA-C
Physician Assistant
703 RIGBY LAKE DR
RIGBY, ID 83442
Jefferson County (208) 745-0200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dermatology Of Eastern Idaho PA's NPI number?

The NPI number for Dermatology Of Eastern Idaho PA is 1548259161. It was assigned to this organization in the NPPES registry on October 17, 2005.

Where is Dermatology Of Eastern Idaho PA located?

Dermatology Of Eastern Idaho PA is located at 703 Rigby Lake Dr, Rigby, ID 83442. The listed phone number is (208) 745-0200.

What is Dermatology Of Eastern Idaho PA's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Dermatology Of Eastern Idaho PA was last updated on June 30, 2010. NPI Profile syncs with the weekly NPPES data releases published by CMS.