NPIMap

Organization Active NPI

Pocatello Health Services, LLC

  • General Acute Care Hospital
  • Pocatello, ID
National Provider Identifier
1689802852
Registry record updated Jun 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
12 Issued in ID
Legal business name
POCATELLO HEALTH SERVICES, LLC
Practice address
651 Memorial Dr
Pocatello, ID 83201-4071
Phone
(208) 239-2110
Fax
(208) 239-2145
NPI assigned
Jun 26, 2009
Last updated
Jun 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2009

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

Authorized official

Name
Jonathan R Wilker
Title
VP Finance & Cfo
Phone
(208) 239-1000

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
Phone (208) 239-2110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090701000646 ID Part B Supplier - Clinic/Group Practice 6608927637 Receives reassigned benefits from 225 practitioners
1 other NPI on this enrollment
Practice locations: Twin Falls, ID; Soda Springs, ID; Pocatello, ID; Montpelier, ID; Burley, ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 319

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.

View all 319

NPI Registry JSON

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

{
    "created_epoch": "1245974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245974400000",
    "number": "1689802852",
    "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",
            "telephone_number": "208-239-2110",
            "fax_number": "208-239-2145"
        },
        {
            "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",
            "fax_number": "208-239-2145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POCATELLO HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-26",
        "last_updated": "2009-06-26",
        "status": "A",
        "authorized_official_last_name": "WILKER",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "VP FINANCE & CFO",
        "authorized_official_telephone_number": "208-239-1000"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "ID",
            "license": "12",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jun 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.