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NPI Code Detail

MEDICARE: RANDELL L PAGE D.O.

MEDICARE: RANDELL L PAGE D.O.
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
1207R00000XInternal Medicine Physician088ID

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3110057530OTHERIDRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1S0883OTHERIDBLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4000010006056OTHERIDBLUE SHIELD

General Provider Information

NPI Number : 1750370771
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDELL L PAGE D.O.
Provider Business Mailing Address
First Line : 190 E BANNOCK ST
Second Line :
City : BOISE
State : ID
Zip : 83712-6241
Country : US
Telephone Number : 208-381-2222
Fax Number : 208-463-3044
Provider Business Practice Location Address
First Line : 215 E HAWAII AVE
Second Line :
City : NAMPA
State : ID
Zip : 83686-6011
Country : US
Telephone Number : 208-463-3234
Fax Number : 208-463-3044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 12/18/2013

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Directions to “ RANDELL L PAGE D.O.” Practice Location

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