MEDICARE: STUART BLACK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01060962A	IN
2	207Q00000X	Family Medicine Physician	M-9850	ID

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11000133	OTHER	ID	MEDICARE PTAN
2	11000131	OTHER	ID	MEDICARE PTAN
3	P00777176	OTHER	ID	MEDICARE RAILROAD PTAN
5	11000132	OTHER	ID	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	M9850	OTHER	ID	IDAHO LICENSE

General Provider Information

NPI Number	:	1053351361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STUART BLACK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83653-0009
Country	:	US
Telephone Number	:	208-466-7869
Fax Number	:	208-466-5359

Provider Business Practice Location Address
First Line	:	223 16TH AVE N
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-4058
Country	:	US
Telephone Number	:	208-466-7869
Fax Number	:	208-466-5359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	05/27/2025

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Directions to “ STUART BLACK M.D.” Practice Location

Language	Start Address	Practice Location

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