Southfork Healthcare

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SOUTHFORK HEALTHCARE

Practice address

166 Elk Path
Swan Valley, ID 83449-0101

Phone

(208) 360-1997

NPI assigned

Apr 1, 2013

Organization subpart

No

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

Authorized official

Name

Wendy Swope, NPNPI 1962522409

Title

Administrator

Phone

(208) 360-1997

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wendy Swope, ACNPC

  • Acute Care Nurse Practitioner
  • Idaho Falls, ID
  • NPI 1962522409
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685318400000",
    "number": "1134462856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 101",
            "city": "SWAN VALLEY",
            "state": "ID",
            "postal_code": "834490101",
            "telephone_number": "208-360-1997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 ELK PATH",
            "city": "SWAN VALLEY",
            "state": "ID",
            "postal_code": "834490101",
            "telephone_number": "208-360-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHFORK HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-01",
        "last_updated": "2023-05-29",
        "certification_date": "2023-05-29",
        "status": "A",
        "authorized_official_last_name": "SWOPE",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-360-1997",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Canyon Steps, LLC
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• Dara Johnston
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• Alison Tanner Wright, NP

• Primary Care Clinic/Center in Swan Valley, ID
• Providers in Swan Valley, 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 May 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.