Pocatello Pulmonary PC

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

M5647 Issued in ID

Legal business name

POCATELLO PULMONARY PC

Practice address

500 S 11TH Ave
Suite 305
Pocatello, ID 83201-4835

Phone

(208) 233-5864

NPI assigned

Aug 10, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Cary V Jackson, M.D.

Title

President

Phone

(208) 233-5864

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Steven M Krawtz, M.D.

  • Pulmonary Disease Physician
  • Pocatello, ID
  • NPI 1972563310
  NPD (past)
• Debra R Ray, PA

  • Medical Physician Assistant
  • Pocatello, ID
  • NPI 1730149865
  NPD (past)
• James A Christon, M.D.

  • Pulmonary Disease Physician
  • Eugene, OR
  • NPI 1619984853
  NPD (past)

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497766240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S 11TH AVE",
            "address_2": "SUITE 305",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014835",
            "telephone_number": "208-233-5864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S 11TH AVE",
            "address_2": "SUITE 305",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014835",
            "telephone_number": "208-233-5864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POCATELLO PULMONARY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CARY",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-233-5864",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "ID",
            "license": "M5647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pocatello Orthopaedics and Sports Medicine Institute PA
• Pocatello PA Service LLC
• Pocatello Physical Therapy
• Pocatello Physical Therapy Clinic PA
• Pocatello Podiatry Associates PA
• Pocatello Rehabilitation PA
• Pocatello Wellness Clinic, LLC
• Jacie Jean Pollard, M.S., CCC-SLP
• Rick Pongratz, PH.D.
• Justin C Pool, PA-C

• Pulmonary Disease Physician in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Pulmonary Disease Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.