NPIMap

Organization Active NPI

CT Clancy MD LLC

  • Psychiatry Physician
  • Boise, ID
National Provider Identifier
1558639971
Registry record updated Dec 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
M-11479 Issued in ID
Legal business name
CT CLANCY MD LLC
Practice address
413 N Allumbaugh St
Suite 101
Boise, ID 83704-9212
Phone
(208) 323-1125
Fax
(208) 323-9604
NPI assigned
Dec 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2011

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

Authorized official

Name
Alison Dunbar
Title
Billing Manager
Phone
(208) 954-5572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X M-11479 ID Primary

Addresses

Primary practice location

413 N Allumbaugh St
Suite 101
Boise, ID 83704-9212

Mailing address

413 N Allumbaugh St
Suite 101
Boise, ID 83704-9212
Phone (208) 323-1125

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323734400000",
    "number": "1558639971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 N ALLUMBAUGH ST",
            "address_2": "SUITE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049212",
            "telephone_number": "208-323-1125",
            "fax_number": "208-323-9604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 N ALLUMBAUGH ST",
            "address_2": "SUITE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049212",
            "telephone_number": "208-323-1125",
            "fax_number": "208-323-9604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CT CLANCY MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-13",
        "last_updated": "2011-12-13",
        "status": "A",
        "authorized_official_last_name": "DUNBAR",
        "authorized_official_first_name": "ALISON",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "208-954-5572"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "M-11479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; 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.