Provider Demographics
NPI:1598305922
Name:REBEKAH GUY
Entity Type:Organization
Organization Name:REBEKAH GUY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-342-2104
Mailing Address - Street 1:115 W MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-7303
Mailing Address - Country:US
Mailing Address - Phone:208-342-2104
Mailing Address - Fax:208-549-7559
Practice Address - Street 1:115 W MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7303
Practice Address - Country:US
Practice Address - Phone:208-342-2104
Practice Address - Fax:208-549-7559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEACON PAIN CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID009509Medicaid