MEDICARE: BONNEVILLE SCHOOL DIST #93

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	225X00000X	Occupational Therapist
3	225100000X	Physical Therapist
4	163W00000X	Registered Nurse
5	251300000X	Local Education Agency (LEA)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538150081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BONNEVILLE SCHOOL DIST #93

Provider Business Mailing Address
First Line	:	3549 N AMMON RD
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-1301
Country	:	US
Telephone Number	:	208-525-4400
Fax Number	:	208-525-4410

Provider Business Practice Location Address
First Line	:	3549 N AMMON RD
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-1301
Country	:	US
Telephone Number	:	208-525-4400
Fax Number	:	208-525-4410

Authorized Official
Title or Position	:	CHIEF FINANCIAL & OPERATIONS OFFICE
Name	:	MR. GUY J WANGSGARD
Credential	:
Telephone Number	:	208-557-6803

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	09/12/2025

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Directions to “BONNEVILLE SCHOOL DIST #93 ” Practice Location

Language	Start Address	Practice Location

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