1811750458 NPI number — PRIMARY PEAK LLC

Table of content: DR. DAVEY DONALD HERRING M.D. (NPI 1629180971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811750458 NPI number — PRIMARY PEAK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY PEAK LLC
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:
1811750458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
523 SHERRY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAMPA
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83686-8874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-821-1188
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 N ORCHARD ST
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:
83706-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-331-6700
Provider Business Practice Location Address Fax Number:
208-331-6707
Provider Enumeration Date:
02/05/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLEMAN
Authorized Official First Name:
JENNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-821-1188

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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