Provider Demographics
NPI:1225326515
Name:SAWTOOTH EPIDEMIOLOGY AND INFECTIOUS DISEASES P.C.
Entity Type:Organization
Organization Name:SAWTOOTH EPIDEMIOLOGY AND INFECTIOUS DISEASES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASI
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-338-0148
Mailing Address - Street 1:125 E IDAHO ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6255
Mailing Address - Country:US
Mailing Address - Phone:208-338-0148
Mailing Address - Fax:208-336-4027
Practice Address - Street 1:125 E IDAHO ST STE 203
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6255
Practice Address - Country:US
Practice Address - Phone:208-338-0148
Practice Address - Fax:208-336-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1369105Medicare Oscar/Certification