OrganizationActive
Burn and Reconstructive Centers of Idaho, PLLC
NPI 1902360639 · Specialist · Idaho Falls, ID
Burn and Reconstructive Centers of Idaho, PLLC is a Specialist organization in Idaho Falls, ID (NPI 1902360639).
Provider details
- NPI number
- 1902360639
- Entity type
- Organization
- Primary specialty
- SpecialistOther Service Providers
- Organization subpart
- No
- Authorized official
- Shawn Fagan, Owner/Md(706) 863-9595
Specialties & taxonomies
Other Service Providers
Profile Score
Detailed profile(76/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
5 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3100 Channing Way
Idaho Falls, ID 83404-7533
Phone: (706) 863-9595
Fax: (706) 868-8375
Street-level locationGet directions
Mailing address
Po Box 12358
Augusta, GA 30914-2358
Additional practice locations (4)
- 2325 Coronado StIdaho Falls, ID 83404-7407Phone: (706) 863-9595Fax: (706) 868-8375
- 3200 Channing Way Ste 206a&bIdaho Falls, ID 83404-7546Phone: (706) 863-9595Fax: (706) 868-8375
- 3901 W 15th StPlano, TX 75075-7738Phone: (706) 863-9595Fax: (706) 868-8375
- 7700 Floyd Curl DrSan Antonio, TX 78229-3902Phone: (706) 863-9595Fax: (706) 868-8375
Registry dates
- Enumerated
- 2019-01-28
- Last updated
- 2022-10-11
- Certified
- 2022-10-11
Frequently asked questions
- What is Burn and Reconstructive Centers of Idaho, PLLC's NPI number?
- Burn and Reconstructive Centers of Idaho, PLLC's National Provider Identifier (NPI) is 1902360639, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Burn and Reconstructive Centers of Idaho, PLLC?
- Burn and Reconstructive Centers of Idaho, PLLC is classified in the NPPES registry as Specialist (Other Service Providers).
- Where is Burn and Reconstructive Centers of Idaho, PLLC located?
- Burn and Reconstructive Centers of Idaho, PLLC's practice location on file with NPPES is 3100 Channing Way, Idaho Falls, ID 83404-7533.
- What is Burn and Reconstructive Centers of Idaho, PLLC's phone number?
- The practice phone number listed in the NPPES registry for Burn and Reconstructive Centers of Idaho, PLLC is (706) 863-9595.
- Who is the authorized official for Burn and Reconstructive Centers of Idaho, PLLC?
- The authorized official listed on Burn and Reconstructive Centers of Idaho, PLLC's NPPES record is Shawn Fagan, Owner/Md. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Burn and Reconstructive Centers of Idaho, PLLC's NPI active?
- Yes — Burn and Reconstructive Centers of Idaho, PLLC's NPI (1902360639) is active in the NPPES registry as of the last update on 2022-10-11.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.