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Contact Information

MICHAEL R DIBENEDETTO MD PLLC
30544 HWY 200
STE 102
PONDERAY, ID83852
 Phone: 208-265-9836
 Fax: 208-263-7249
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
 

Rehabilitation: Cardiac Facilities

261QR0404X
Indicates primary specialty

NPI Profile & details for MICHAEL R DIBENEDETTO MD PLLC

NPI Number 1083809727
LBN Legal business name MICHAEL R DIBENEDETTO MD PLLC
Authorized official DANIEL GARMAN - (PRACTICE MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 09/06/2007
Last updated 05/07/2021 - About 5 years ago
Identifiers
ID Medicaid 806452000
ID Other 8N259 BLUE CROSS
ID Other DG3627 PALMETTO GBA RAILROAD MED
ID Other 000010140056 REGENCE BLUE SHIELD
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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