Provider Demographics
NPI:1255385837
Name:F. B. FITTS JR., M.D. PC
Entity type:Organization
Organization Name:F. B. FITTS JR., M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:FITTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:208-420-8991
Mailing Address - Street 1:PO BOX 1886
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-1886
Mailing Address - Country:US
Mailing Address - Phone:208-736-0887
Mailing Address - Fax:
Practice Address - Street 1:1344 HILAND AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1564
Practice Address - Country:US
Practice Address - Phone:208-678-1138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010155405OtherREGENCE
ID807411600Medicaid
ID8M816OtherBLUE CROSS
ID8M816OtherBLUE CROSS