NPIMap

Organization Active NPI

Center Street Health Care LLC

  • Family Nurse Practitioner
  • Pocatello, ID
National Provider Identifier
1417104530
Registry record updated Sep 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP252A Issued in ID
Legal business name
CENTER STREET HEALTH CARE LLC
Practice address
1553 E Center St
Pocatello, ID 83201-4135
Phone
(208) 233-9355
Fax
(208) 233-9300
NPI assigned
Aug 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2008

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

Authorized official

Name
Ms. Cynthia Marie Rice, RNCNPNPI 1427041763
Title
Owner/Provider
Phone
(208) 233-9355

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X NP252A ID Primary

Addresses

Primary practice location

1553 E Center St
Pocatello, ID 83201-4135

Mailing address

1553 E Center St
Pocatello, ID 83201-4135
Phone (208) 233-9355

Other identifiers 1

IdentifierTypeStateIssuer
004383300MedicaidID

National Provider Directory

National Provider Directory

Locations

1553 E Center St
Side A
Pocatello, ID 83201
Phone (208) 233-9355

Practitioners & affiliated clinicians

Practitioners 2

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": "1219190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222732800000",
    "number": "1417104530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1553 E CENTER ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014135",
            "telephone_number": "208-233-9355",
            "fax_number": "208-233-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1553 E CENTER ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014135",
            "telephone_number": "208-233-9355",
            "fax_number": "208-233-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER STREET HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-20",
        "last_updated": "2008-09-30",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "208-233-9355",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RNCNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP252A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004383300",
            "state": "ID"
        }
    ],
    "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 30, 2008; 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.