NPIMap

Organization Active NPI

Payette Lakes Medical Clinic, PA

  • Primary Care Clinic/Center
  • McCall, ID
National Provider Identifier
1255462263
Registry record updated Mar 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PAYETTE LAKES MEDICAL CLINIC, PA
Practice address
211 Forest Street
McCall, ID 83638
Phone
(208) 634-2225
Fax
(208) 634-7212
NPI assigned
Mar 8, 2007
Last updated
Mar 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2008

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

Authorized official

Name
Jacqueline R. Bruns
Title
VP - Physician Services
Phone
(208) 634-4061

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

211 Forest Street
McCall, ID 83638

Mailing address

PO Box 1047
McCall, ID 83638-1047
Phone (208) 634-2225

Other identifiers 2

IdentifierTypeStateIssuer
000010006343OtherIDBLUE SHIELD
8934-2OtherIDBLUE CROSS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205193600000",
    "number": "1255462263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1047",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836381047",
            "telephone_number": "208-634-2225",
            "fax_number": "208-634-7212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 FOREST STREET",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "83638",
            "telephone_number": "208-634-2225",
            "fax_number": "208-634-7212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAYETTE LAKES MEDICAL CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2008-03-11",
        "status": "A",
        "authorized_official_last_name": "BRUNS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "VP - PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "208-634-4061"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010006343",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8934-2",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McCall, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; 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.