Aurora Medical

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

AURORA MEDICAL

Practice address

348 W Clark St
Pocatello, ID 83204-3148

Phone

(208) 242-3376

Fax

(208) 242-3245

NPI assigned

Jul 30, 2019

Organization subpart

No

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

Authorized official

Name

Travis Williams

Title

Owner

Phone

(208) 251-9985

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1564444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585785600000",
    "number": "1215581087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "348 W CLARK ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832043148",
            "telephone_number": "208-242-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "348 W CLARK ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832043148",
            "telephone_number": "208-242-3376",
            "fax_number": "208-242-3245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AURORA MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-30",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-251-9985"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.