NPIMap

Organization Active NPI

Southeastern Idaho Developmental Center, Inc.

  • Case Management Agency
  • Blackfoot, ID
National Provider Identifier
1235264318
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
SOUTHEASTERN IDAHO DEVELOPMENTAL CENTER, INC.
Practice address
765 W Judicial St
Blackfoot, ID 83221-2036
Phone
(208) 782-1301
Fax
(208) 782-3627
NPI assigned
Feb 22, 2007
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
Jim P. McCoy
Title
Owner Director
Phone
(208) 782-1301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary

Addresses

Primary practice location

765 W Judicial St
Blackfoot, ID 83221-2036

Mailing address

PO Box 701
Blackfoot, ID 83221-0701
Phone (208) 782-1301

National Provider Directory

National Provider Directory
Tax ID family
Southeastern Idaho Developmental Center Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235264318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 701",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832210701",
            "telephone_number": "208-782-1301",
            "fax_number": "208-782-3627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 W JUDICIAL ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832212036",
            "telephone_number": "208-782-1301",
            "fax_number": "208-782-3627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN IDAHO DEVELOPMENTAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "JIM",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "OWNER DIRECTOR",
        "authorized_official_telephone_number": "208-782-1301"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blackfoot, 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.