NPIMap

Organization Active NPI

Idaho Dept of Health & Welfare Reg II CMH Moscow

  • Rehabilitation Clinic/Center
  • Moscow, ID
National Provider Identifier
1720116551
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
IDAHO DEPT OF HEALTH & WELFARE REG II CMH MOSCOW
Practice address
1350 Troy Hwy
Moscow, ID 83543-3995
Phone
(208) 882-0562
Fax
(208) 882-8575
NPI assigned
Mar 1, 2007
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
Vicki R. Malone, MSW
Title
Program Manager
Phone
(208) 799-4440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X NU Primary

Addresses

Primary practice location

1350 Troy Hwy
Moscow, ID 83543-3995

Mailing address

1350 Troy Hwy
Moscow, ID 83543-3995
Phone (208) 882-0562

Other identifiers 3

IdentifierTypeStateIssuer
000010018450OtherBLUE SHIELD
8073500MedicaidID
HW140OtherBLUE CROSS OF IDAHO

National Provider Directory

National Provider Directory
Tax ID family
Idaho Dept of Health Welfare Reg II Amh Grangeville114 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720116551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 TROY HWY",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "835433995",
            "telephone_number": "208-882-0562",
            "fax_number": "208-882-8575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 TROY HWY",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "835433995",
            "telephone_number": "208-882-0562",
            "fax_number": "208-882-8575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DEPT OF HEALTH & WELFARE REG II CMH MOSCOW",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MALONE",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "208-799-4440",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010018450",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8073500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "HW140",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moscow, 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.