NPIMap

Organization Active NPI

Center for Lifetime Health

Doing business as Colleen Shackelford, LLC

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1689744963
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M5741 Issued in ID
Legal business name
CENTER FOR LIFETIME HEALTH
Doing business as
Colleen Shackelford, LLC
Practice address
300 E Bannock St
Boise, ID 83712
Phone
(208) 342-7400
Fax
(208) 342-1879
NPI assigned
Nov 8, 2006
Last updated
Jul 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

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

Authorized official

Name
Colleen Shackelford, DNPNPI 1104107317
Title
Owner
Phone
(208) 342-7400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M5741 ID Primary

Addresses

Primary practice location

300 E Bannock St
Boise, ID 83712

Mailing address

300 E Bannock St
Boise, ID 83712
Phone (208) 342-7400

Other names 1

  • Colleen Shackelford, LLC Doing business as

National Provider Directory

National Provider Directory

Locations

111 W Main St
Boise, ID 83702
Phone (208) 342-7400

5865 W Hidden Springs Dr
Boise, ID 83714
Phone (208) 342-7400

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690243200000",
    "number": "1689744963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83712",
            "telephone_number": "208-342-7400",
            "fax_number": "208-342-1879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83712",
            "telephone_number": "208-342-7400",
            "fax_number": "208-342-1879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR LIFETIME HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A",
        "authorized_official_last_name": "SHACKELFORD",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-342-7400",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M5741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colleen Shackelford, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 25, 2023; 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.