Michael Ray Haskell, PA-C
Physician Assistant, Medical in Driggs, ID. Individual provider (NPI-1).
NPI number1457794083
StatusActive
Last updated in NPPESDec 14, 2016
Details
- NPI
- 1457794083
- Entity type
- Individual (NPI-1)
- Name
- Michael Ray Haskell
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 13, 2013
- Last updated
- Dec 14, 2016
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | 576 | WY | Yes |
| 363AS0400X | Physician Assistant, Surgical | 576 | WY |
Practice location
120 East Howard AvenueTeton Valley Health Care
Driggs, ID 83422-5112
Phone 208-354-6302 · Fax 208-354-3158
Mailing address
120 East Howard AvenueTeton Valley Health Care
Driggs, ID 83422-5112
Phone 208-354-6352 · Fax 208-354-3158
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