1023336161 NPI number — GEM INNOVATION SCHOOLS OF IDAHO, INC.

Table of content: DR. GREGORIO TRINIDAD LIM M.D. (NPI 1629172168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023336161 NPI number — GEM INNOVATION SCHOOLS OF IDAHO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEM INNOVATION SCHOOLS OF IDAHO, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023336161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 86
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARY
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83823-0086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-877-1513
Provider Business Mailing Address Fax Number:
208-877-1713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 SOUTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83823-9683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-877-1513
Provider Business Practice Location Address Fax Number:
208-877-1713
Provider Enumeration Date:
05/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BOGAR
Authorized Official First Name:
LORI
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
208-877-1513

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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