Provider Demographics
NPI:1588769301
Name:MARK S CHOWN MDPA
Entity type:Organization
Organization Name:MARK S CHOWN MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHOWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-466-3322
Mailing Address - Street 1:1611 C 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6182
Mailing Address - Country:US
Mailing Address - Phone:208-466-3322
Mailing Address - Fax:208-465-0392
Practice Address - Street 1:1611 C 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6182
Practice Address - Country:US
Practice Address - Phone:208-466-3322
Practice Address - Fax:208-465-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4350208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR124313Medicaid
ID43505OtherBLUE CROSS TRUE BLUE
ID1114603Medicare ID - Type Unspecified
C36894Medicare UPIN