Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Burn and Reconstructive Centers of Idaho, PLLC

Organization Specialist · NPI 1902360639

Burn and Reconstructive Centers of Idaho, PLLC is a Specialist in Idaho Falls, Idaho. Works from 5 locations. Registered with an NPI since 2019.

In the registry since
2019
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3100 Channing Way
Idaho Falls, ID 83404-7533
Phone: (706) 863-9595
Fax: (706) 868-8375
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (4)

  • 2325 Coronado St, Idaho Falls, ID 83404-7407 — (706) 863-9595
  • 3200 Channing Way Ste 206a&B, Idaho Falls, ID 83404-7546 — (706) 863-9595
  • 3901 W 15th St, Plano, TX 75075-7738 — (706) 863-9595
  • 7700 Floyd Curl Dr, San Antonio, TX 78229-3902 — (706) 863-9595

Specialties & licences

Specialist (primary) Taxonomy 174400000X

Record details

NPI number1902360639
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Shawn Fagan — Owner/Md · (706) 863-9595
NPI enumeratedJanuary 28, 2019
Last updated in NPPESOctober 11, 2022
Certification dateOctober 11, 2022
Mailing addressPo Box 12358, Augusta, GA 30914-2358

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