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General NPI Number Information
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NPI Number | 1215715669
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Entity Type | Organization
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Legal Business Name | GEM STATE ENT, PLLC
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 2102 CANYON PLAZA DR
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City | TWIN FALLS
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State | ID
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Zip | 83301-4513
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Country | US
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Telephone | 208-352-7555
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Fax | 208-352-7333
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Provider Business Mailing Address
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Address Line | 2114 VILLAGE PARK AVE # 200
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City | TWIN FALLS
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State | ID
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Zip | 83301-4172
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Country | US
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Telephone | 208-804-1717
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Fax | 208-804-1707
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Authorized Official
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Title or Position | MEDICAL CODER
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Name | BROOKE FREIDENBERGER
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Credential |
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Telephone | 208-858-6008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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