Provider Demographics
NPI:1578694923
Name:DARRELL A. KAMMER, A PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:DARRELL A. KAMMER, A PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-467-2129
Mailing Address - Street 1:1615 12TH AVE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-7713
Mailing Address - Country:US
Mailing Address - Phone:208-467-2129
Mailing Address - Fax:208-467-2122
Practice Address - Street 1:1615 12TH AVE RD
Practice Address - Street 2:SUITE C
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-7713
Practice Address - Country:US
Practice Address - Phone:208-467-2129
Practice Address - Fax:208-467-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-2935174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID290545OtherBSID
HICK7354OtherRR MEDICARE
ID8K255OtherBCID
ID804259800Medicaid
HICK7354OtherRR MEDICARE
ID804259800Medicaid