NPIMap

Organization Active NPI

K2Red L.L.C.

  • Community/Retail Pharmacy
  • Twin Falls, ID
National Provider Identifier
1295832574
Registry record updated Apr 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
1307CP Issued in ID
Legal business name
K2RED L.L.C.
Practice address
526 Shoup Ave W Ste K
Twin Falls, ID 83301-5050
Phone
(208) 734-7373
Fax
(208) 734-7389
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2008

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

Authorized official

Name
Mr. Daniel Scott Fuchs, RPH
Title
Member
Phone
(208) 734-7373

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1307CP ID
Community/Retail Pharmacy 3336C0003X 1307CP ID Primary
Specialty Pharmacy 3336S0011X 1307CP ID

Addresses

Primary practice location

526 Shoup Ave W Ste K
Twin Falls, ID 83301-5050

Mailing address

526 Shoup Ave W Ste K
Twin Falls, ID 83301-5050
Phone (208) 734-7373

Other identifiers 2

IdentifierTypeStateIssuer
805156900MedicaidID
805182800MedicaidID

Other names 1

  • DICK'S PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930085835 ID DME Supplier - Pharmacy 1557480464 Practice locations: Twin Falls, ID
O20140325001579 ID Part B Supplier - Mass Immunization (Roster Biller Only) 1557480464 3 other NPIs on this enrollment
Practice locations: Twin Falls, ID; Wendell, ID; Jerome, ID; Buhl, ID

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
K2Red LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

801 S Vista Ave
Boise, ID 83705
Phone (208) 364-7777

419 Broadway Ave S
Buhl, ID 83316
Phone (208) 543-5353

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209081600000",
    "number": "1295832574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 SHOUP AVE W STE K",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015050",
            "telephone_number": "208-734-7373",
            "fax_number": "208-734-7389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 SHOUP AVE W STE K",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015050",
            "telephone_number": "208-734-7373",
            "fax_number": "208-734-7389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K2RED L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-04-25",
        "status": "A",
        "authorized_official_last_name": "FUCHS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "208-734-7373",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "ID",
            "license": "1307CP",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "1307CP",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "ID",
            "license": "1307CP",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805156900",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805182800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DICK'S PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.