PHS MD #1, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PHS MD #1, LLC

Practice address

651 Memorial Dr
Pocatello, ID 83201-4071

Phone

(208) 239-2110

Fax

(208) 239-2145

NPI assigned

Nov 17, 2009

Organization subpart

Yes

Parent organization

POCATELLO HEALTH SERVICES, LLCAs reported in NPPES

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

Authorized official

Name

John Abreu

Title

Cfo

Phone

(208) 239-2110

Specialties & licenses 1

Addresses

Other names 1

• PORTNEUF MEDICAL PRACTICES Other name

Tax ID family

PHS MD 1 LLC2 organizations share this tax ID, including this one

Part of

Isu Family Medicine

Other organizations with this tax ID 1

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

• PHS MD #1, LLC

  • Primary Care Clinic/Center
  • Pocatello, ID
  • NPI 1992032098
  NPD tax ID

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

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267488000000",
    "number": "1124355813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4168",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832054168",
            "telephone_number": "208-239-2110",
            "fax_number": "208-239-2145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014071",
            "telephone_number": "208-239-2110",
            "fax_number": "208-239-2145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHS MD #1, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POCATELLO HEALTH SERVICES, LLC",
        "enumeration_date": "2009-11-17",
        "last_updated": "2010-03-02",
        "status": "A",
        "authorized_official_last_name": "ABREU",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "208-239-2110"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PORTNEUF MEDICAL PRACTICES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Paula Brutz Phelps, PA
• Sarah Phelps, PTA
• John Boyatt Phillips, MT
• Nanette Marie Phinney, RN
• PHS Ambulatory Services LLC
• PHS MD #1, LLC
• PHS MD #2, LLC
• Brittney Bonwai Phu
• Physical Therapy Specialists of Idaho
• Physical Therapy Sports & Rehab

• Primary Care Clinic/Center in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Primary Care Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.

Verify at the official NPI Registry.