NPIMap

Organization Active NPI

Saint Alphonsus Nephrology

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burley, ID
National Provider Identifier
1720079387
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
BM5584708 Issued in ID
Legal business name
SAINT ALPHONSUS NEPHROLOGY
Practice address
2303 Park Ave
Burley, ID 83318-2106
Phone
(208) 677-5490
Fax
(208) 677-5498
NPI assigned
Nov 2, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jan M Jacobs
Title
Accounts Receivable Manager
Phone
(208) 367-3076

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X BM5584708 ID Primary

Addresses

Primary practice location

2303 Park Ave
Burley, ID 83318-2106

Mailing address

5610 Gage St
Suite B
Boise, ID 83706-1349
Phone (208) 367-3076

National Provider Directory

National Provider Directory
Tax ID family
Saint Alphonsus Nephrology 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": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720079387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5610 GAGE ST",
            "address_2": "SUITE B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061349",
            "telephone_number": "208-367-3076",
            "fax_number": "208-367-6909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2303 PARK AVE",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182106",
            "telephone_number": "208-677-5490",
            "fax_number": "208-677-5498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT ALPHONSUS NEPHROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "JAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ACCOUNTS RECEIVABLE MANAGER",
        "authorized_official_telephone_number": "208-367-3076"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "ID",
            "license": "BM5584708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burley, ID

Sources for this page

  • 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.