Doctors Clinic of Elmore County PLLC
Organization Active NPI Family Medicine Physician · Mountain Home, ID
NPI 1063578664 · NPPES record last updated Feb 25, 2008
Key facts
- NPI
- 1063578664
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- O-91 (ID)
- Legal business name
- DOCTORS CLINIC OF ELMORE COUNTY PLLC
- Practice address
- 2000 American Legion Blvd
Mountain Home, ID 83647-3138 - Phone
- (208) 587-1500
- Fax
- (208) 587-3180
- NPI assigned
- Dec 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Layne D Roberts, D.O.
- Title
- Physician
- Phone
- (208) 587-1500
Practitioners 3
-
Linda J Hensley, NURSE PRACTITIONER
-
Layne D. Roberts, D.O.
-
Delmar Wallace Smith, P.A.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D0938420 | Doctors Clinic of Elmore County | Provider-performed microscopy | Jul 9, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041012001423 | ID | Part B Supplier - Clinic/Group Practice | 8224098413 |
Receives reassigned benefits from 3 practitioners Practice locations: Mountain Home, ID |
National Provider Directory
Locations
2000 American Legion Blvd
Mountain Home, ID 83647
Phone (208) 587-1500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | O-91 | ID | Yes |
| Physician Assistant |
363A00000X | PA-265 | ID |
Addresses
Primary practice location
2000 American Legion Blvd
Mountain Home, ID 83647-3138
Mailing address
2000 American Legion Blvd
Mountain Home, ID 83647-3138
Phone (208) 587-1500
Other providers in Mountain Home, ID
- Adriana Crompton
- Dennis Dan Crossley
- Elizabeth Ashlea Daffern
- Talmage W Delange
- Dental Center P.L.L.C.
- Doctors of Physical Therapy PLLC
- Samantha Dodge
- Eduardo Dominguez Lino
- James Patrick Doyle
- Joshua Henry Dreschler
All providers in Mountain Home, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.