Provider Demographics
NPI:1609805779
Name:ADA PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:ADA PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-323-1222
Mailing Address - Street 1:650 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9117
Mailing Address - Country:US
Mailing Address - Phone:208-323-1222
Mailing Address - Fax:208-323-1825
Practice Address - Street 1:650 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9117
Practice Address - Country:US
Practice Address - Phone:208-323-1222
Practice Address - Fax:208-323-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010006736OtherREGENCE BS OF IDAHO
86611OtherBLUE CROSS OF IDAHO
86611OtherBLUE CROSS OF IDAHO