Burn and Reconstructive Centers of Idaho, PLLC
NPI 1902360639ActiveOrganization· Specialist· Idaho Falls, ID
Specialist in Idaho Falls, Idaho, registered in NPPES in January 2019. The authorized official on file is Shawn Fagan, Owner/Md.
Overview
| NPI | 1902360639 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 28, 2019 |
| Last updated in NPPES | Oct 11, 2022 |
| Certified by provider | Oct 11, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Specialist Primary | 174400000X | — | — |
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) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other Specialist providers in Idaho Falls
- 1841220910
- 1336540020
- 1780736173
- 1306064910
- 1851571376
- 1518035336
- 1740470558
- 1114220324
- 1124198403
- 1487700464
- 1205030368
- 1477656718