NPIMap

Organization Active NPI

Idaho Pathology Laboratory Physicians

  • Clinical Medical Laboratory
  • Pocatello, ID
National Provider Identifier
1336490119
Registry record updated Jun 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
M11025 Issued in ID
Legal business name
IDAHO PATHOLOGY LABORATORY PHYSICIANS
Practice address
777 Hospital Way
Pocatello, ID 83201
Phone
(208) 232-7666
Fax
(208) 232-2334
NPI assigned
Sep 20, 2012
Last updated
Jun 12, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2013

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

Authorized official

Name
Dr. Kristopher A McGee, M.D., FCAPNPI 1821246596
Title
Owner of Business
Phone
(208) 690-0364

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X M11025 ID Primary
Clinical Medical Laboratory 291U00000X M11088 ID

Addresses

Primary practice location

777 Hospital Way
Pocatello, ID 83201

Mailing address

7069 Running Iron LN
Pocatello, ID 83204-3816
Phone (208) 690-0364

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130729000195 ID Part B Supplier - Independent Clinical Laboratory 0042451460 Practice locations: Pocatello, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1348099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370995200000",
    "number": "1336490119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7069 RUNNING IRON LN",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832043816",
            "telephone_number": "208-690-0364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "83201",
            "telephone_number": "208-232-7666",
            "fax_number": "208-232-2334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO PATHOLOGY LABORATORY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-20",
        "last_updated": "2013-06-12",
        "status": "A",
        "authorized_official_last_name": "MCGEE",
        "authorized_official_first_name": "KRISTOPHER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER OF BUSINESS",
        "authorized_official_telephone_number": "208-690-0364",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., FCAP"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "ID",
            "license": "M11025",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "ID",
            "license": "M11088",
            "primary": false
        }
    ],
    "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 Jun 12, 2013; 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.