NPIMap

Organization Active NPI

Eastern Idaho Neurological Associates PA

  • Neurology Physician
  • Idaho Falls, ID
National Provider Identifier
1437252723
Registry record updated Jan 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
M6269 Issued in ID
Legal business name
EASTERN IDAHO NEUROLOGICAL ASSOCIATES PA
Practice address
2353 Coronado Drive
Idaho Falls, ID 83404
Phone
(208) 552-4823
Fax
(208) 552-4856
NPI assigned
Sep 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2015

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

Authorized official

Name
Stephen G Vincent, MD
Title
Owner
Phone
(208) 552-4823

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X M6269 ID Primary

Addresses

Primary practice location

2353 Coronado Drive
Idaho Falls, ID 83404

Mailing address

2353 Coronado Drive
Idaho Falls, ID 83404
Phone (208) 552-4823

Other identifiers 1

IdentifierTypeStateIssuer
002724000MedicaidID

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420502400000",
    "number": "1437252723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2353 CORONADO DRIVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-552-4823",
            "fax_number": "208-552-4856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2353 CORONADO DRIVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-552-4823",
            "fax_number": "208-552-4856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN IDAHO NEUROLOGICAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2015-01-06",
        "status": "A",
        "authorized_official_last_name": "VINCENT",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-552-4823",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "ID",
            "license": "M6269",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002724000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; 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.