NPIMap

Organization Active NPI

Portneuf Nephrology Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pocatello, ID
National Provider Identifier
1164413753
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
BM7847203 Issued in ID
Legal business name
PORTNEUF NEPHROLOGY CENTER
Practice address
2001 Bench Rd
Pocatello, ID 83201-2033
Phone
(208) 637-1090
Fax
(208) 637-1097
NPI assigned
Nov 2, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Jan M Jacobs
Title
Accounts Receivable Manager
Phone
(208) 367-3076

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X BM7847203 ID Primary

Addresses

Primary practice location

2001 Bench Rd
Pocatello, ID 83201-2033

Mailing address

5610 Gage St
Boise, ID 83706-1332
Phone (208) 367-3076

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164413753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5610 GAGE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061332",
            "telephone_number": "208-367-3076",
            "fax_number": "208-367-6909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 BENCH RD",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012033",
            "telephone_number": "208-637-1090",
            "fax_number": "208-637-1097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTNEUF NEPHROLOGY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "JAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ACCOUNTS RECEIVABLE MANAGER",
        "authorized_official_telephone_number": "208-367-3076",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "ID",
            "license": "BM7847203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.