Active NPI
Anna L Blackford
- Private Vehicle
- Sagle, ID
National Provider Identifier
1114236429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Private Vehicle
- License
- QK307464B
- Practice address
- 455 39 G Rd
Sagle, ID 83860-8960 - Phone
- (208) 290-1079
- NPI assigned
- Oct 4, 2010
- Last updated
- Oct 4, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Private Vehicle | 347C00000X | QK307464B | ID | Primary |
Addresses
Primary practice location
455 39 G Rd
Sagle, ID 83860-8960
Mailing address
PO Box 573
Ponderay, ID 83852-0573
Phone (208) 290-1079
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| QK307464B | ID | MD | Private Vehicle |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286150400000",
"number": "1114236429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 573",
"city": "PONDERAY",
"state": "ID",
"postal_code": "838520573",
"telephone_number": "208-290-1079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 39 G RD",
"city": "SAGLE",
"state": "ID",
"postal_code": "838608960",
"telephone_number": "208-290-1079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKFORD",
"first_name": "ANNA",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-04",
"last_updated": "2010-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": "ID",
"license": "QK307464B",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.