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BURN AND RECONSTRUCTIVE CENTERS OF IDAHO, PLLC
NPI 1902360639
Specialist in Idaho Falls, ID

Active since January 28, 2019
3100 CHANNING WAY, IDAHO FALLS, ID 83404(706) 863-9595(706) 868-8375 Get Directions Write a Review

NPPES record last updated: October 11, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 11, 2022, Oct 5, 2022, May 25, 2022 and 6 more (9 updates tracked since 2019).

About Burn And Reconstructive Centers Of Idaho, Pllc NPPES

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

BURN AND RECONSTRUCTIVE CENTERS OF IDAHO, PLLC (NPI 1902360639) is a healthcare organization registered as a specialist in Idaho Falls, Idaho and active in the NPI registry since January 2019. The organization maintains 4 additional practice locations and lists Shawn Fagan, Owner/md, as its authorized official.

NPPES Registry Identity

NPI1902360639
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameBURN AND RECONSTRUCTIVE CENTERS OF IDAHO, PLLC
Location Address3100 CHANNING WAYIdaho Falls, ID 83404-7533
Mailing AddressPo Box 12358Augusta, GA 30914-2358 · (706) 863-9595 · Fax (706) 868-8375
Phone(706) 863-9595
Fax(706) 868-8375
Organization SubpartNo
Authorized OfficialShawn FaganOwner/md · (706) 863-9595
Enumeration DateJanuary 28, 2019
Last NPPES UpdateOctober 11, 20229 updates tracked since enumeration
NPPES CertifiedOctober 11, 2022
✔ NPI 1902360639 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
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.
3100 CHANNING WAY, Idaho Falls, ID 83404
Open in Google Maps ↗

Secondary Practice Locations 4

Location 17700 Floyd Curl DrSan Antonio, TX 78229-3902 · Phone (706) 863-9595 · Fax (706) 868-8375
Location 22325 Coronado StIdaho Falls, ID 83404-7407 · Phone (706) 863-9595 · Fax (706) 868-8375
Location 33200 Channing Way Ste 206A&bIdaho Falls, ID 83404-7546 · Phone (706) 863-9595 · Fax (706) 868-8375
Location 43901 W 15th StPlano, TX 75075-7738 · Phone (706) 863-9595 · Fax (706) 868-8375

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.

CARL SAMUEL BRAYTON DO
Student in an Organized Health Care Education/Training Program
3100 CHANNING WAY
IDAHO FALLS, ID 83404
Bonneville County (714) 616-4454
REED D LOERTSCHER CRNA
Nurse Anesthetist, Certified Registered
3100 CHANNING WAY
IDAHO FALLS, ID 83404
Bonneville County (208) 529-6285
ALEXIS R SIDDOWAY NP
Nurse Practitioner (Neonatal)
3100 CHANNING WAY
IDAHO FALLS, ID 83404
Bonneville County (208) 535-4432
UNIVERSITY OF UTAH ADULT SERVICES
Internal Medicine (Nephrology)
3100 CHANNING WAY
IDAHO FALLS, ID 83404
Bonneville County (801) 581-2121
MR. VENKATA KALYAN C BYRAPOGU MD
Student in an Organized Health Care Education/Training Program
3100 CHANNING WAY
IDAHO FALLS, ID 83404
Bonneville County (208) 970-1123
TAYLOR JAMES CARSON
Student in an Organized Health Care Education/Training Program
3100 CHANNING WAY
IDAHO FALLS, ID 83404
Bonneville County (208) 670-0407
NOOR ASHRAF NASSEF DO
Student in an Organized Health Care Education/Training Program
3100 CHANNING WAY
IDAHO FALLS, ID 83404
Bonneville County (208) 529-6111
DR. ALAN B WRAY M.D.
Radiology (Diagnostic Radiology)
3100 CHANNING WAY
IDAHO FALLS, ID 83404
Bonneville County (208) 227-2600

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 Burn And Reconstructive Centers Of Idaho, PLLC's NPI number?

The NPI number for Burn And Reconstructive Centers Of Idaho, PLLC is 1902360639. It was assigned to this organization in the NPPES registry on January 28, 2019.

Where is Burn And Reconstructive Centers Of Idaho, PLLC located?

Burn And Reconstructive Centers Of Idaho, PLLC is located at 3100 Channing Way, Idaho Falls, ID 83404. The listed phone number is (706) 863-9595.

What is Burn And Reconstructive Centers Of Idaho, PLLC'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 Burn And Reconstructive Centers Of Idaho, PLLC was last updated on October 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.