MEDICARE: WILLIAM C FITZHUGH MD PA

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	207W00000X	Ophthalmology Physician	M9542	ID

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	:	1427096148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM C FITZHUGH MD PA

Provider Business Mailing Address
First Line	:	1415 PARKVIEW DR
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-3250
Country	:	US
Telephone Number	:	208-734-8934
Fax Number	:	208-734-8974

Provider Business Practice Location Address
First Line	:	1415 PARKVIEW DR
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-3250
Country	:	US
Telephone Number	:	208-734-8934
Fax Number	:	208-734-8974

Authorized Official
Title or Position	:	CEO
Name	:	DR. JAMES COOMBS
Credential	:	M.D.
Telephone Number	:	208-734-8934

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	11/16/2015

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