Portneuf Medical Center

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

H12 Issued in ID

Legal business name

PORTNEUF MEDICAL CENTER

Practice address

651 Memorial Dr
Pocatello, ID 83201-4071

Phone

(208) 239-1000

Fax

(208) 239-2112

NPI assigned

Jun 12, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Johnathan Wilker

Title

VP Finance & Cfo

Phone

(208) 239-1020

Specialties & licenses 1

Addresses

Other names 1

• Portneuf Care Center Other name

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326080599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014071",
            "telephone_number": "208-239-1000",
            "fax_number": "208-239-2112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014071",
            "telephone_number": "208-239-1000",
            "fax_number": "208-239-2112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTNEUF MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILKER",
        "authorized_official_first_name": "JOHNATHAN",
        "authorized_official_title_or_position": "VP FINANCE & CFO",
        "authorized_official_telephone_number": "208-239-1020"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": "H12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portneuf Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Portneuf Brace Company, LLC
• Portneuf Dental PLLC (Superior Smiles)
• Portneuf Home Health Care, LLC (Portneuf Home Health Care)
• Portneuf Medical Center
• Portneuf Medical Center
• Portneuf Medical Center
• Portneuf Medical Center
• Portneuf Medical Center
• Portneuf Medical Center
• Portneuf Medical Center

• Skilled Nursing Facility in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Skilled Nursing Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.