Provider Demographics
NPI:1730190836
Name:MACHA, MATTHEW R (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:MACHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2045
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-9110
Mailing Address - Country:US
Mailing Address - Phone:208-343-5600
Mailing Address - Fax:208-779-2898
Practice Address - Street 1:323 E RIVERSIDE DR STE 220
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5246
Practice Address - Country:US
Practice Address - Phone:208-343-5600
Practice Address - Fax:208-779-2898
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM6834208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010001037OtherREGENCE BS BOI
ID000010144925OtherREGENBE BS MTN HOME
ID020030135OtherTRICARE
ID002279400Medicaid
IDB3861OtherBLUE CROSS OF ID EMMETT
ID000010149831OtherREGENCE BS EMMETT
IDB3879OtherBC OF IDAHO MTN HOME
ID70334OtherBLUE CROSS OF IDAHO BOIS