NPI age
5 years
Enumerated 2020-06-09
● Active Type 2 · Organization
Subpart
Idaho Endoscopy Center Llc
Idaho Endoscopy Center Llc is 1 of 99 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Mallory
Manager
Last NPPES update
2020-07-30
Source: monthly bulk 2026-05
How this organization compares
Across 99 active clinic/center providers in Idaho.
NPI age
5 years
↓ 13 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2020 → 2026
2020-06Enumerated in NPPES
2020
2026
Where they practice
Primary practice location
5080 E Commerce St
Nampa, ID 836875513
Mailing address
6259 W Emerald St
Boise, ID 837048731
Authorized official
Mark A Mallory, MD
Manager
📞 2084891900
Individual providers at this organization
2 individual providers on file at this primary practice address.
- Riley Anderson, PA-C Physician Assistant NPI 1790677375
- Troy Carr Nurse Practitioner NPI 1275250102
Specialties
-
Clinic/Center PrimaryDefinition to come...
Other names on file (2)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Nampa Idaho Endoscopy Center
-
Nampa Idaho Endoscopy Center
Practice context
Multi-provider organization. 2 individual providers on file at this primary address.
Subpart of Idaho Endoscopy Center Llc.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.