Snake River Ear, Nose & Throat PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

A89785 Issued in ID

Legal business name

SNAKE RIVER EAR, NOSE & THROAT PC

Practice address

706 North College Road
Suite C
Twin Falls, ID 83301

Phone

(208) 735-1000

Fax

(208) 732-5345

NPI assigned

Oct 4, 2006

Organization subpart

No

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

Authorized official

Name

Rod Kack, MD

Title

Owner

Phone

(208) 735-1000

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358208000000",
    "number": "1104912740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 NORTH COLLEGE ROAD",
            "address_2": "SUITE C",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "83301",
            "telephone_number": "208-735-1000",
            "fax_number": "208-732-5345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 NORTH COLLEGE ROAD",
            "address_2": "SUITE C",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "83301",
            "telephone_number": "208-735-1000",
            "fax_number": "208-732-5345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SNAKE RIVER EAR, NOSE & THROAT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2013-01-15",
        "status": "A",
        "authorized_official_last_name": "KACK",
        "authorized_official_first_name": "ROD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-735-1000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "ID",
            "license": "A89785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805168100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Vaughn Smith, PH.D.
• Tomais Jed Smith, LMSW
• Trevor Parker Smith, D.D.S.
• Smiths Food & Drug Centers Inc
• Kelly Smothers, LPC, ICADC,SAP
• Snake River Gastroenterology Labs, L.L.C.
• Snake River Medical Services, Inc.
• Snake River Urology, P.C.
• Snake River Wound Care and Hyperbarics LLC
• Vanessa Snow, AUD

• Specialist in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.