Star Medical Center PC

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

Legal business name

STAR MEDICAL CENTER PC

Practice address

9858 W State St
Star, ID 83669-5210

Phone

(208) 286-0666

Fax

(208) 286-0565

NPI assigned

Jan 16, 2007

Organization subpart

No

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

Authorized official

Name

Elmer G Dodge Jr., RNP

Title

President Owner

Phone

(208) 286-0666

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368489600000",
    "number": "1508918244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44267",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837110267",
            "telephone_number": "208-286-0666",
            "fax_number": "208-286-0565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9858 W STATE ST",
            "city": "STAR",
            "state": "ID",
            "postal_code": "836695210",
            "telephone_number": "208-286-0666",
            "fax_number": "208-286-0565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR MEDICAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2013-05-14",
        "status": "A",
        "authorized_official_last_name": "DODGE",
        "authorized_official_first_name": "ELMER",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "208-286-0666",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RNP"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ID",
            "identifier": "8L030",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807071100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Registered Nurse in Star, ID
• Providers in Star, ID by specialty
• General Practice Registered Nurse in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; 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.