Provider Demographics
NPI:1699723569
Name:CALL, THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:CALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1758
Mailing Address - Country:US
Mailing Address - Phone:208-782-3700
Mailing Address - Fax:208-782-3765
Practice Address - Street 1:9 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1702
Practice Address - Country:US
Practice Address - Phone:208-782-3700
Practice Address - Fax:208-782-3765
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO222207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDS4026OtherBCID
ID000010150482OtherREGENCE BLUE SHIELD
ID312944OtherALTIUS
IDS5643OtherBLUE CROSS OLD
ID000010140863OtherBSID
MT1699723569Medicaid
IDS6114OtherBLUE CROSS
ID266530OtherALTIUS OLD
UTZ3649Medicaid
ID13019501Medicare PIN
ID312944OtherALTIUS
MT1699723569Medicaid
ID1301953Medicare PIN
IDS4026OtherBCID
ID1303005Medicare PIN