Provider Demographics
NPI:1366810442
Name:SCHOLES DERMATOLOGY LLC
Entity type:Organization
Organization Name:SCHOLES DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THAD
Authorized Official - Last Name:SCHOLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-734-5555
Mailing Address - Street 1:PO BOX 31001-3306
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-3306
Mailing Address - Country:US
Mailing Address - Phone:208-734-5555
Mailing Address - Fax:208-734-4790
Practice Address - Street 1:526 SHOUP AVE W STE A
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5050
Practice Address - Country:US
Practice Address - Phone:208-734-5555
Practice Address - Fax:208-734-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1366810442Medicaid
ID1558313528Medicaid