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Michael Allan Hallstrom

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

This provider is enrolled in PECOS as MICHAEL HALLSTROM.

Based on the most recent information from CMS, provider Michael Allan Hallstrom is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 9:43 AM.

Profile Details

Provider ID
1972950210
Provider Type
Individual
Full Name
Hallstrom, Michael Allan
Credential
PA-C

Gender
Male
Sole Proprietor
No
Enumeration Date
5/17/2016
Last Updated
3/17/2018

Contact Information

Practice Location

190 E Bannock St, Boise, ID 83712-6241

(208) 381-5015

(208) 381-1873

Mailing Location

190 E Bannock St, Boise, ID 83712-6241

(208) 381-5015

(208) 381-1873

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer Idaho

Michael Allan Hallstrom

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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Idaho Surgical Assistants Pllc

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Blea, Kacey

Bowman, Dustin K

Talford, David B

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Manko, Marc

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