McCall Memorial Hospital

Primary specialty

Critical Access Hospital Clinic/CenterTaxonomy code 261QC0050X

License

11 Issued in ID

Legal business name

MCCALL MEMORIAL HOSPITAL

Doing business as

Donnelly Medical Clinic, a MMH Physician Clinic

Practice address

454 West Roseberry Rd, Suite 103
Donnelly, ID 83615

Phone

(208) 325-4455

Fax

(208) 325-4466

NPI assigned

Mar 9, 2007

Last updated

Feb 15, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

MCCALL MEMORIAL HOSPITALAs reported in NPPES

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

Authorized official

Name

Karen J Kellie

Title

President

Phone

(208) 634-2221

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Donnelly Medical Clinic, a MMH Physician Clinic Doing business as

Part of

McCall Medical Clinics

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203033600000",
    "number": "1265564967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 STATE ST",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836383704",
            "telephone_number": "208-634-2221",
            "fax_number": "208-634-7112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 WEST ROSEBERRY RD, SUITE 103",
            "city": "DONNELLY",
            "state": "ID",
            "postal_code": "83615",
            "telephone_number": "208-325-4455",
            "fax_number": "208-325-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCALL MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCCALL MEMORIAL HOSPITAL",
        "enumeration_date": "2007-03-09",
        "last_updated": "2008-02-15",
        "status": "A",
        "authorized_official_last_name": "KELLIE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-634-2221"
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "ID",
            "license": "11",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ID CLINIC",
            "identifier": "8M977",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE CLINIC NUMBER",
            "identifier": "000010159605",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Donnelly Medical Clinic, a MMH Physician Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan K Drake, MD, RDN
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• Kelly Companies, LLC (Mountain Valley Counseling & Outdoor Therapy)
• Korena Popp FNP Medical Services LLC (The Change Clinic)
• Annalee Mangum, RN
• Mountain Mobile Medicine, PLLC
• Payette Lakes Medical Clinic, PA
• Taylor Rae, P-LCSW
• Sellers DMD PC
• Kimberly Ruth Smith, RN, BSN, CLC

• Clinic/Center in Donnelly, ID
• Providers in Donnelly, ID by specialty
• Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.