Provider Demographics
NPI:1538108394
Name:ARTHRITIS CENTER OF IDAHO,PA
Entity Type:Organization
Organization Name:ARTHRITIS CENTER OF IDAHO,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AKAVARAM
Authorized Official - Middle Name:NARSIMHA
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-814-8150
Mailing Address - Street 1:775 POLE LINE RD W
Mailing Address - Street 2:SUITE 115
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5814
Mailing Address - Country:US
Mailing Address - Phone:208-814-8150
Mailing Address - Fax:208-732-3112
Practice Address - Street 1:775 POLE LINE RD W
Practice Address - Street 2:SUITE 115
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5814
Practice Address - Country:US
Practice Address - Phone:208-814-8150
Practice Address - Fax:208-732-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9605207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807465000Medicaid
IDDF0268OtherRR MEDICARE
ID807465000Medicaid