Provider Demographics
NPI:1982641882
Name:DONALD G PICA MD PA
Entity Type:Organization
Organization Name:DONALD G PICA MD PA
Other - Org Name:IDAHO RHEUMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:PICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-732-3236
Mailing Address - Street 1:660 SHOSHONE ST E
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6110
Mailing Address - Country:US
Mailing Address - Phone:208-732-3236
Mailing Address - Fax:208-732-3112
Practice Address - Street 1:660 SHOSHONE ST E
Practice Address - Street 2:SUITE 210
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6110
Practice Address - Country:US
Practice Address - Phone:208-732-3236
Practice Address - Fax:208-732-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003889200Medicaid
ID1109078Medicare ID - Type UnspecifiedMEDICARE NUMBER
IDP00035234Medicare PIN