NPIMap

Organization Active NPI

Idaho Behavioral Health, Inc.

  • Family Medicine Physician
  • Mountain Home, ID
National Provider Identifier
1053658138
Registry record updated Jan 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-4112 Issued in ID
Legal business name
IDAHO BEHAVIORAL HEALTH, INC.
Practice address
2420 American Legion Blvd
Mountain Home, ID 83647-3146
Phone
(208) 580-9525
Fax
(208) 580-9527
NPI assigned
Jan 10, 2013
Last updated
Jan 10, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2013

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

Authorized official

Name
Tami Jones, LCSW
Title
President and Ceo
Phone
(208) 343-2737

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M-4112 ID Primary

Addresses

Primary practice location

2420 American Legion Blvd
Mountain Home, ID 83647-3146

Mailing address

2273 S Vista Ave
#190
Boise, ID 83705-7341
Phone (208) 343-2737

National Provider Directory

National Provider Directory
Tax ID family
Idaho Behavioral Health Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

2420 American Legion Blvd
Mountain Home, ID 83647
Phone (208) 580-9525

NPI Registry JSON

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

{
    "created_epoch": "1357776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357776000000",
    "number": "1053658138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2273 S VISTA AVE",
            "address_2": "#190",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837057341",
            "telephone_number": "208-343-2737",
            "fax_number": "208-342-3238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 AMERICAN LEGION BLVD",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836473146",
            "telephone_number": "208-580-9525",
            "fax_number": "208-580-9527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO BEHAVIORAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-10",
        "last_updated": "2013-01-10",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "208-343-2737",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-4112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; 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.