Healthcare Provider Details

I. General information

NPI: 1063851889
Provider Name (Legal Business Name): JEREMY CHAD RINDLISBACHER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3765 HWY 20
ISLAND PARK ID
83429
US

IV. Provider business mailing address

3765 HWY 20
ISLAND PARK ID
83429
US

V. Phone/Fax

Practice location:
  • Phone: 208-558-7766
  • Fax: 208-558-0768
Mailing address:
  • Phone: 208-558-7766
  • Fax: 208-558-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1551
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60379809
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60379809
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: