1326009648 NPI number — PUBLIC HEALTH DISTRICT IV

Table of content: (NPI 1326009648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326009648 NPI number — PUBLIC HEALTH DISTRICT IV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUBLIC HEALTH DISTRICT IV
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326009648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 N ARMSTRONG PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83704-0825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-375-5211
Provider Business Mailing Address Fax Number:
208-327-8500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 N ARMSTRONG PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83704-0825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-375-5211
Provider Business Practice Location Address Fax Number:
208-327-8500
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCMURTRY
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC MANAGER
Authorized Official Telephone Number:
208-327-7400

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X , with the licence number: N/A PUBLIC HEALTH AG ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 805808800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002469400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002831400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806152200 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: DH041 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010007076 . This is a "REGENCE BLUE SHIELD OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002469200 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002469700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806919800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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