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Contact Information

ADAM MATTHEWS, DPM
1555 E CLARK ST
POCATELLO, ID83201-4133
 Phone: 224-688-0624
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
 

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for ADAM MATTHEWS · (Male)

NPI # 1134411408
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 05/05/2011
Last updated 03/18/2021 - About 5 years ago
Sole proprietor 1 Yes
Identifiers
  • ID License # P216
  • ID Medicaid 000391
Hospital affiliation(s)
  • BEAR LAKE MEMORIAL HOSPITAL - (Critical Access)
    164 SOUTH FIFTH STREET
    MONTPELIER, ID 83254
  • CARIBOU MEMORIAL HOSPITAL - (Critical Access)
    300 SOUTH 3RD WEST
    SODA SPRINGS, ID 83276
  • PORTNEUF MEDICAL CENTER - (Acute Care)
    777 HOSPITAL WAY
    POCATELLO, ID 83201
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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