MEDICARE: TROY BACON BA

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	171M00000X	Case Manager/Care Coordinator		ID

General Provider Information

NPI Number	:	1588319578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY BACON BA

Provider Business Mailing Address
First Line	:	1035 E HUNTER DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-3481
Country	:	US
Telephone Number	:	208-996-4202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 E HUNTER DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-3481
Country	:	US
Telephone Number	:	208-996-9795
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2022
Last Update Date	:	03/02/2026

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Directions to “ TROY BACON BA” Practice Location

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