NPIMap

Organization Active NPI

Impact

  • Social Worker
  • Rigby, ID
National Provider Identifier
1437317682
Registry record updated May 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Legal business name
IMPACT
Practice address
152 E Main St Ste 106
Rigby, ID 83442-5268
Phone
(208) 745-7831
Fax
(208) 745-0658
NPI assigned
May 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2008

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

Authorized official

Name
Bruce Hampton, LSW
Title
Owner/LSW
Phone
(208) 522-8899

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 104100000X Primary

Addresses

Primary practice location

152 E Main St Ste 106
Rigby, ID 83442-5268

Mailing address

PO Box 2106
Idaho Falls, ID 83403-2106
Phone (208) 745-7831

Other identifiers 1

IdentifierTypeStateIssuer
807738600MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Impact4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

152 E Main St
Ste 106
Rigby, ID 83442
Phone (208) 522-8899

NPI Registry JSON

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

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1437317682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2106",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834032106",
            "telephone_number": "208-745-7831",
            "fax_number": "208-745-0658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 E MAIN ST STE 106",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425268",
            "telephone_number": "208-745-7831",
            "fax_number": "208-745-0658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-23",
        "last_updated": "2008-05-27",
        "status": "A",
        "authorized_official_last_name": "HAMPTON",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER/LSW",
        "authorized_official_telephone_number": "208-522-8899",
        "authorized_official_credential": "LSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807738600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rigby, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.