Total Life Clinic PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

TOTAL LIFE CLINIC PLLC

Practice address

2311 Park Ave
Unit 2 Suite 6&8
Burley, ID 83318-2104

Phone

(208) 878-6413

Fax

(208) 878-6417

NPI assigned

Apr 8, 2016

Last updated

Mar 16, 2023By 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

Shelbyann Bernice Aldridge

Title

Office Manager

Phone

(208) 878-6413

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15480/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1460073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1467816199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 PARK AVE",
            "address_2": "UNIT 2 SUITE 6&8",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182104",
            "telephone_number": "208-878-6413",
            "fax_number": "208-878-6417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2311 PARK AVE",
            "address_2": "UNIT 2 SUITE 6&8",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182104",
            "telephone_number": "208-878-6413",
            "fax_number": "208-878-6417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1625 Addison Ave E",
            "address_purpose": "LOCATION",
            "city": "Twin Falls",
            "state": "ID",
            "postal_code": "833015343",
            "country_code": "US",
            "telephone_number": "208-878-6413",
            "fax_number": "208-878-6417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TOTAL LIFE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-08",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "ALDRIDGE",
        "authorized_official_first_name": "SHELBYANN",
        "authorized_official_middle_name": "BERNICE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-878-6413"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467816199",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Burley, ID
• Providers in Burley, ID by specialty
• Primary Care Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; 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.