NPIMap

Organization Active NPI

Physician Center a Professional Company Mid Level

  • Family Medicine Physician
  • Twin Falls, ID
National Provider Identifier
1245414028
Registry record updated Mar 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PHYSICIAN CENTER A PROFESSIONAL COMPANY MID LEVEL
Practice address
775 Pole Line Rd W
Suite 105 & 111
Twin Falls, ID 83301-5814
Phone
(208) 814-8000
Fax
(208) 733-9402
NPI assigned
Dec 28, 2007
Last updated
Mar 9, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2013

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

Authorized official

Name
Mitchell J Moffitt, MDNPI 1093895229
Title
Physician
Phone
(208) 814-8000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Pediatrics Physician 208000000X

Addresses

Primary practice location

775 Pole Line Rd W
Suite 105 & 111
Twin Falls, ID 83301-5814

Mailing address

775 Pole Line Rd W
Suite 105 & 111
Twin Falls, ID 83301-5814
Phone (208) 814-8000

Other identifiers 1

IdentifierTypeStateIssuer
8050368MedicaidID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1198800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362787200000",
    "number": "1245414028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W",
            "address_2": "SUITE 105 & 111",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015814",
            "telephone_number": "208-814-8000",
            "fax_number": "208-733-9402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W",
            "address_2": "SUITE 105 & 111",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015814",
            "telephone_number": "208-814-8000",
            "fax_number": "208-733-9402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN CENTER A PROFESSIONAL COMPANY MID LEVEL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-28",
        "last_updated": "2013-03-09",
        "status": "A",
        "authorized_official_last_name": "MOFFITT",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "208-814-8000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8050368",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.