Deb Elliott-Pearson M.D., P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M7469 Issued in ID

Legal business name

DEB ELLIOTT-PEARSON M.D., P.C.

Doing business as

Bank Street Clinic

Practice address

516 Bank St
Wallace, ID 83873-2225

Phone

(208) 752-3016

Fax

(208) 753-1001

NPI assigned

Apr 23, 2008

Last updated

Apr 29, 2008By 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

Dr. Deborah Lois Elliott-Pearson, M.D.

Title

Ceo

Phone

(208) 752-3016

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bank Street Clinic Doing business as

Locations

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1619142452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 BANK ST",
            "city": "WALLACE",
            "state": "ID",
            "postal_code": "838732225",
            "telephone_number": "208-752-3016",
            "fax_number": "208-753-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 BANK ST",
            "city": "WALLACE",
            "state": "ID",
            "postal_code": "838732225",
            "telephone_number": "208-752-3016",
            "fax_number": "208-753-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEB ELLIOTT-PEARSON M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT-PEARSON",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "LOIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-752-3016",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M7469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805230000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bank Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Wallace, ID
• Providers in Wallace, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 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.