1841212933 NPI number — PUBLIC HEALTH DISTRICT 1

Table of content: (NPI 1841212933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841212933 NPI number — PUBLIC HEALTH DISTRICT 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUBLIC HEALTH DISTRICT 1
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:
1841212933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8500 N ATLAS ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAYDEN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83835-7677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-786-7474
Provider Business Mailing Address Fax Number:
208-786-7109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8500 N ATLAS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYDEN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83835-8332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-415-5100
Provider Business Practice Location Address Fax Number:
208-415-5161
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUFFY
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
208-415-5163

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000270500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: DH124 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: DH132 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010023565 . This is a "REGENCE BLUE SHIELD OF ID" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 000010024099 . This is a "REGENCE BLUE SHIELD OF ID" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 000010008200 . This is a "REGENCE BLUE SHIELD OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002843400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: DH0017 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: DJ780 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002470500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010018276 . This is a "REGENCE BLUE SHIELD OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: DH116 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010021347 . This is a "REGENCE BLUE SHIELD OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002834500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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