NPIMap

Organization Active NPI

Community Care Pocatello PLLC

  • Urgent Care Clinic/Center
  • Pocatello, ID
National Provider Identifier
1265714760
Registry record updated Sep 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
COMMUNITY CARE POCATELLO PLLC
Practice address
1595 Yellowstone Ave
Pocatello, ID 83201-4203
Phone
(208) 233-0032
Fax
(208) 237-9171
NPI assigned
Sep 12, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2011

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

Authorized official

Name
Derek Campbell, D.O.
Title
Member
Phone
(208) 233-0032

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

1595 Yellowstone Ave
Pocatello, ID 83201-4203

Mailing address

1595 Yellowstone Ave
Pocatello, ID 83201-4203
Phone (208) 233-0032

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315785600000",
    "number": "1265714760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1595 YELLOWSTONE AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014203",
            "telephone_number": "208-233-0032",
            "fax_number": "208-237-9171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1595 YELLOWSTONE AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014203",
            "telephone_number": "208-233-0032",
            "fax_number": "208-237-9171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE POCATELLO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-12",
        "last_updated": "2011-09-12",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "208-233-0032",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; 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.