BLUE LAKES GASTROENTEROLOGY PLLC
NPI 1821299553
Nurse Practitioner in Twin Falls, ID

Q: What is Blue Lakes Gastroenterology PLLC's NPI number?

The NPI number for Blue Lakes Gastroenterology PLLC is 1821299553. It was assigned to this organization in the NPPES registry on May 30, 2007.

Q: What is Blue Lakes Gastroenterology PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Active since May 30, 2007

775 POLE LINE RD W, SUITE 203, TWIN FALLS, ID 83301(208) 814-8300(208) 733-8970 Get Directions Write a Review

NPPES record last updated: March 9, 2013. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Blue Lakes Gastroenterology Pllc NPPES

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

BLUE LAKES GASTROENTEROLOGY PLLC (NPI 1821299553) is a healthcare organization registered as a nurse practitioner in Twin Falls, Idaho and active in the NPI registry since May 2007. The organization lists Robert Ward, Physician, as its authorized official.

NPPES Registry Identity

NPI1821299553

Entity TypeOrganization

Primary Taxonomy363L00000X

Legal Business NameBLUE LAKES GASTROENTEROLOGY PLLC

Location Address775 POLE LINE RD W, SUITE 203Twin Falls, ID 83301-5814

Mailing Address775 Pole Line Rd W, Suite 203Twin Falls, ID 83301-5814 · (208) 814-8300 · Fax (208) 733-8970

Phone(208) 814-8300

Fax(208) 733-8970

Organization SubpartNo

Authorized OfficialRobert WardPhysician · (208) 814-8300

Enumeration DateMay 30, 2007

Last NPPES UpdateMarch 9, 2013

✔ NPI 1821299553 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

775 POLE LINE RD W, Twin Falls, ID 83301

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Other Identifiers 1

Medicaid807132400ID

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

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

DR. MITCHELL JACKSON MOFFITT M.D.

Pediatrics

775 POLE LINE RD W, SUITE 111
TWIN FALLS, ID 83301

Twin Falls County (208) 814-8000

DR. RONALD WILLIAM BLAIR D.O.

Surgery

775 POLE LINE RD W, SUITE 212
TWIN FALLS, ID 83301

Twin Falls County (208) 814-8400

JOHN A BAKER M.D.

Internal Medicine

775 POLE LINE RD W, SUITE 302
TWIN FALLS, ID 83301

Twin Falls County (208) 814-8600

BLUE LAKES GASTROENTEROLOGY, PLLC

Internal Medicine (Gastroenterology)

775 POLE LINE RD W, SUITE 203
TWIN FALLS, ID 83301

Twin Falls County (208) 814-8300

KOVIC SHANE BAILEY DO

Family Medicine

775 POLE LINE RD W
TWIN FALLS, ID 83301

Twin Falls County (208) 814-8000

DANIEL G PREUCIL M.D.

Family Medicine

775 POLE LINE RD W, SUITE 105
TWIN FALLS, ID 83301

Twin Falls County (208) 814-8000

BRUCE C MCCOMAS M.D.

Surgery

775 POLE LINE RD W, SUITE 212
TWIN FALLS, ID 83301

Twin Falls County (208) 814-8400

PHYSICIAN CENTER A PROFESSIONAL COMPANY MID LEVEL

Family Medicine

775 POLE LINE RD W, SUITE 105 & 111
TWIN FALLS, ID 83301

Twin Falls County (208) 814-8000

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 Blue Lakes Gastroenterology PLLC's NPI number?

The NPI number for Blue Lakes Gastroenterology PLLC is 1821299553. It was assigned to this organization in the NPPES registry on May 30, 2007.

Where is Blue Lakes Gastroenterology PLLC located?

Blue Lakes Gastroenterology PLLC is located at 775 Pole Line Rd W Suite 203, Twin Falls, ID 83301. The listed phone number is (208) 814-8300.

What is Blue Lakes Gastroenterology PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

When was this NPI record last updated?

The NPPES record for Blue Lakes Gastroenterology PLLC was last updated on March 9, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.