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Contact Information

DEAN W RODEMACK, PA-C
401 W CAMAS AVE
FAIRFIELD, ID83327
 Phone: 208-764-2611
 Fax: 208-933-4921
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for DEAN W RODEMACK · (Male)

NPI # 1548543424
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 09/27/2011
Last updated 04/08/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • ID License # PA-1020
  • WA License # PA60245393
  • WA Medicaid 158543424
  • WA Other 0285610 LABOR & INDUSTRIES
Hospital affiliation(s)
  • NORTH CANYON MEDICAL CENTER - (Critical Access)
    267 NORTH CANYON DR
    GOODING, ID 83330
  • ST LUKES MAGIC VALLEY RMC - (Acute Care)
    801 POLE LINE ROAD WEST
    TWIN FALLS, ID 83301
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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