NPIMap

Organization Active NPI

South Park, Inc.

  • Case Management Agency
  • Pocatello, ID
National Provider Identifier
1003021676
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
SOUTH PARK, INC.
Practice address
415 S Arthur Ave
Pocatello, ID 83204-3303
Phone
(208) 233-6833
Fax
(208) 233-6842
NPI assigned
May 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Russell C McCoy, M.A.ED
Title
Executive Director
Phone
(208) 233-6833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X ID Primary

Addresses

Primary practice location

415 S Arthur Ave
Pocatello, ID 83204-3303

Mailing address

415 S Arthur Ave
Pocatello, ID 83204-3303
Phone (208) 233-6833

Other names 1

  • Developmental Options Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Developmental Options8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003021676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S ARTHUR AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832043303",
            "telephone_number": "208-233-6833",
            "fax_number": "208-233-6842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S ARTHUR AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832043303",
            "telephone_number": "208-233-6833",
            "fax_number": "208-233-6842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PARK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "208-233-6833",
        "authorized_official_credential": "M.A.ED"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Developmental Options",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.