OrganizationActive
Gem State Pediatrics
NPI 1992853386 · Pediatrics Physician · Meridian, ID
Provider details
- NPI number
- 1992853386
- Entity type
- Organization
- Primary specialty
- Pediatrics PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Mario Brus, Owner
- License
- M5562 (ID)
Practice location
520 S Eagle Rd
Suite 1209
Meridian, ID 83642-6308
Phone: (208) 706-5460
Fax: (208) 706-5465
Mailing address
520 S Eagle Rd
Meridian, ID 83642-6308
Registry dates
- Enumerated
- 2007-01-08
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.