Mountain Health Services PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M8355 Issued in ID

Legal business name

MOUNTAIN HEALTH SERVICES PC

Practice address

740 McKinley Ave
Kellogg, ID 83837-2693

Phone

(208) 783-1267

Fax

(208) 786-4471

NPI assigned

Aug 25, 2006

Organization subpart

No

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

Authorized official

Name

Frederick R Haller, M.D.

Title

Medical Director

Phone

(208) 783-1267

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360800000000",
    "number": "1164539912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 MCKINLEY AVE",
            "city": "KELLOGG",
            "state": "ID",
            "postal_code": "838372693",
            "telephone_number": "208-783-1267",
            "fax_number": "208-786-4471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 MCKINLEY AVE",
            "city": "KELLOGG",
            "state": "ID",
            "postal_code": "838372693",
            "telephone_number": "208-783-1267",
            "fax_number": "208-786-4471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN HEALTH SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2013-02-14",
        "status": "A",
        "authorized_official_last_name": "HALLER",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "208-783-1267",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M8355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002790500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "000010006537",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC9834",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "8A570",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gwen Lorraine McKee, APRN
• Megan Mills, LPC
• Amanda Morse
• Erin Lydon Mottonen, PTA
• Mountain Health Mid Level
• Kathleen Nansel, BA, CFSP
• Shannon Marie Nansel, PEER SUPPORT SPECIAL
• Neil Orlew Norman, DDS
• North Idaho Eye Clinics, Inc.
• Amanda Rae Olson, LCSW

• Family Medicine Physician in Kellogg, ID
• Providers in Kellogg, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2013; 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.