Snake River Dermatology, PA
NPI 1528263670ActiveOrganization· Dermatology· Fruitland, ID
Dermatology in Fruitland, Idaho, registered in NPPES in June 2007. The authorized official on file is Brock Arben Andersen, MD, Principal Officer. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1528263670 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 19, 2007 |
| Last updated in NPPES | Feb 4, 2013 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | M-11462 | ID |
| Dermatology | 207N00000X | M3809 | ID |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (ID) |
|---|
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