NPIMap

Organization Active NPI

Portneuf Medical Center

  • General Acute Care Hospital
  • Pocatello, ID
National Provider Identifier
1679742209
Registry record updated Feb 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
12 Issued in ID
Legal business name
PORTNEUF MEDICAL CENTER
Practice address
651 Memorial Dr
Pocatello, ID 83201-4071
Phone
(208) 239-2110
NPI assigned
Feb 28, 2008
Last updated
Feb 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2008

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

Authorized official

Name
Kerry Wright
Title
Enrollment Specialist
Phone
(208) 239-2110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 12 ID Primary

Addresses

Primary practice location

651 Memorial Dr
Pocatello, ID 83201-4071

Mailing address

651 Memorial Dr
Pocatello, ID 83201-4071

Other identifiers 1

IdentifierTypeStateIssuer
8076635MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Portneuf Medical Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204156800000",
    "number": "1679742209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014071",
            "telephone_number": "208-239-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTNEUF MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "last_updated": "2008-02-28",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "KERRY",
        "authorized_official_title_or_position": "ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "208-239-2110"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "ID",
            "license": "12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8076635",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 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.