NPIMap

Organization Active NPI

PHS Ambulatory Services LLC

  • Urgent Care Clinic/Center
  • Pocatello, ID
National Provider Identifier
1306524152
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
PHS AMBULATORY SERVICES LLC
Practice address
2850 Olympus Dr
Pocatello, ID 83201-2271
Phone
(208) 239-2273
NPI assigned
Jul 10, 2023
Last updated
Oct 3, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
POCATELLO HEALTH SYSTEM, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

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

Authorized official

Name
Stephen Petrovich
Title
Evp General Counsel
Phone
(615) 296-3594

Specialties & licenses 1

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

Addresses

Primary practice location

2850 Olympus Dr
Pocatello, ID 83201-2271

Mailing address

340 Seven Springs Way Ste 100
Brentwood, TN 37027-5697

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231115000800 ID Part B Supplier - Clinic/Group Practice 6507213402 Receives reassigned benefits from 6 practitioners
Practice locations: Chubbuck, ID; Pocatello, ID

National Provider Directory

National Provider Directory

Locations

230 Bullock St
Chubbuck, ID 83202
Phone (208) 242-4220

Practitioners & affiliated clinicians

Practitioners 11

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": "1688947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1306524152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 SEVEN SPRINGS WAY STE 100",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 OLYMPUS DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012271",
            "telephone_number": "208-239-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHS AMBULATORY SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POCATELLO HEALTH SYSTEM, LLC",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "EVP GENERAL COUNSEL",
        "authorized_official_telephone_number": "615-296-3594"
    },
    "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 Oct 3, 2023; 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.