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General NPI Number Information
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NPI Number | 1881100097
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Entity Type | Organization
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Legal Business Name | NORTHWEST GASTROENTEROLOGY, PLLC
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 526 SHOUP AVE W
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City | TWIN FALLS
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State | ID
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Zip | 83301-6050
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Country | US
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Telephone | 208-736-7620
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Fax | 855-830-4058
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Provider Business Mailing Address
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Address Line | 2156 EAGLECREST DR
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City | FILER
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State | ID
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Zip | 83328-5068
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Country | US
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Telephone | 503-505-3628
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | JUDITH ERIKA CSANKY
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Credential | MD
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Telephone | 503-505-3628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | M-11559
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License Number State | ID
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