Southern Idaho Diabetes Education Program

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SOUTHERN IDAHO DIABETES EDUCATION PROGRAM

Practice address

108 NW Rail St
Shoshone, ID 83352

Phone

(208) 944-4747

Fax

(208) 886-2634

NPI assigned

Oct 7, 2008

Last updated

Oct 7, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

SHOSHONE FAMILY MEDICAL CENTERAs reported in NPPES

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

Authorized official

Name

Kathryn Evalena Pike, RN, CDE

Title

Sidep Coordinator

Phone

(208) 944-4747

Specialties & licenses 1

Addresses

Part of

Keith E Davis

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Keith E Davis, M.D.

  • Family Medicine Physician
  • Shoshone, ID
  • NPI 1043277635
  NPD

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1154572311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 S APPLE ST",
            "city": "SHOSHONE",
            "state": "ID",
            "postal_code": "833525287",
            "telephone_number": "208-886-6222",
            "fax_number": "208-886-2634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 NW RAIL ST",
            "city": "SHOSHONE",
            "state": "ID",
            "postal_code": "83352",
            "telephone_number": "208-944-4747",
            "fax_number": "208-886-2634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN IDAHO DIABETES EDUCATION PROGRAM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHOSHONE FAMILY MEDICAL CENTER",
        "enumeration_date": "2008-10-07",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "PIKE",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "EVALENA",
        "authorized_official_title_or_position": "SIDEP COORDINATOR",
        "authorized_official_telephone_number": "208-944-4747",
        "authorized_official_credential": "RN, CDE"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Daniel Ritcheson
• Stephanie Roberts, PA
• Janet Sandy
• Shoshone Rehab and Living Center
• Shoshone School District No. 312
• Megan Richardson Williams, RD, LD
• Sarah Zohner, COTA

• Primary Care Clinic/Center in Shoshone, ID
• Providers in Shoshone, 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 Oct 7, 2008; 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.