NPIMap

Organization Active NPI

SHH Medical Group North Idaho, LLC

  • Primary Care Clinic/Center
  • Coeur D Alene, ID
National Provider Identifier
1679103485
Registry record updated Jan 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SHH MEDICAL GROUP NORTH IDAHO, LLC
Practice address
1221 W Ironwood Dr Ste 102
Coeur D Alene, ID 83814-1402
Phone
(208) 773-7731
Fax
(208) 665-8112
NPI assigned
Jan 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2020

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

Authorized official

Name
Jason Fletcher
Title
President
Phone
(208) 376-7298

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1221 W Ironwood Dr Ste 102
Coeur D Alene, ID 83814-1402

Mailing address

PO Box 1176
Meridian, ID 83680-1176
Phone (208) 376-7298

Other names 1

  • AUTUMN RIDGE MEDICAL GROUP Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1679103485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1176",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836801176",
            "telephone_number": "208-376-7298",
            "fax_number": "208-377-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 W IRONWOOD DR STE 102",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838141402",
            "telephone_number": "208-773-7731",
            "fax_number": "208-665-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHH MEDICAL GROUP NORTH IDAHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-376-7298"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AUTUMN RIDGE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coeur D Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.