State of Idaho

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

13-7001 Issued in ID

Legal business name

STATE OF IDAHO

Doing business as

Southeastern District Health Department

Practice address

1901 Alvin Ricken Dr
Pocatello, ID 83201-2727

Phone

(208) 239-5210

Fax

(208) 478-6306

NPI assigned

Jul 7, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Edward A. Marugg, R.E.H.S

Title

Director

Phone

(208) 233-9080

Specialties & licenses 1

Addresses

Other names 1

• Southeastern District Health Department Doing business as

Locations

Practitioners 2

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

• Shaunna Rae Kramer, NP-C

  • Family Nurse Practitioner
  • Pocatello, ID
  • NPI 1457822652
  NPD (past)
• Ian Michael Troesoyer, FNP-C

  • Family Nurse Practitioner
  • North Logan, UT
  • NPI 1841859501
  NPD (past)

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649277393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 ALVIN RICKEN DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012727",
            "telephone_number": "208-239-5210",
            "fax_number": "208-478-6306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 ALVIN RICKEN DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012727",
            "telephone_number": "208-239-5210",
            "fax_number": "208-478-6306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARUGG",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "208-233-9080",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.E.H.S"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "ID",
            "license": "13-7001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern District Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matthew S Stanger, MOTR/L
• Shelbie Stanger, PTA
• Christine Stanislowski
• State of Idaho
• State of Idaho
• State of Idaho
• State of Idaho
• State of Idaho
• Tiffany Statham
• Catalina Steckbauer, MS, RN

• Home Health Agency in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Home Health Agency 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.