Provider Demographics
NPI:1750371894
Name:DAVID N. SIM, M.D.,P.A.
Entity type:Organization
Organization Name:DAVID N. SIM, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:SIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:208-376-8666
Mailing Address - Street 1:6014 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8855
Mailing Address - Country:US
Mailing Address - Phone:208-376-8666
Mailing Address - Fax:208-376-9804
Practice Address - Street 1:6014 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8855
Practice Address - Country:US
Practice Address - Phone:208-376-8666
Practice Address - Fax:208-376-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3561261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002451500Medicaid
ID35618OtherBLUE CROSS
ID000010001844OtherBLUE SHIELD
ID35618OtherBLUE CROSS
ID1111330Medicare ID - Type Unspecified