NPIMap

Organization Active NPI

Idaho Dept of Health & Welfare Itp Region 6

  • Early Intervention Provider Agency
  • Pocatello, ID
National Provider Identifier
1164563508
Registry record updated Aug 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
Legal business name
IDAHO DEPT OF HEALTH & WELFARE ITP REGION 6
Practice address
421 Memorial Dr
Pocatello, ID 83201-4008
Phone
(208) 234-7900
Fax
(208) 236-6328
NPI assigned
Feb 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2013

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

Authorized official

Name
Ms. Mary J Jones, B.U.S.
Title
Program Manager
Phone
(208) 334-5523

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Local Education Agency (LEA) 251300000X
Early Intervention Provider Agency 252Y00000X ID Primary

Addresses

Primary practice location

421 Memorial Dr
Pocatello, ID 83201-4008

Mailing address

421 Memorial Dr
Pocatello, ID 83201-4008
Phone (208) 234-7900

Other identifiers 3

IdentifierTypeStateIssuer
000010019386OtherIDBLUE SHIELD
0028414MedicaidID
HW165OtherIDBLUE CROSS OF IDAHO

National Provider Directory

National Provider Directory
Tax ID family
Reg VI Mental Health Ctr114 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375660800000",
    "number": "1164563508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014008",
            "telephone_number": "208-234-7900",
            "fax_number": "208-236-6328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014008",
            "telephone_number": "208-234-7900",
            "fax_number": "208-236-6328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DEPT OF HEALTH & WELFARE ITP REGION 6",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2013-08-05",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "208-334-5523",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "B.U.S."
    },
    "taxonomies": [
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010019386",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0028414",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "HW165",
            "state": "ID"
        }
    ],
    "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 5, 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.