Dominican Health Services

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

00189759321500 Issued in OR

Legal business name

DOMINICAN HEALTH SERVICES

Practice address

1118 NW 16TH St
Fruitland, ID 83619-2271

Phone

(208) 452-6851

Fax

(541) 881-7156

NPI assigned

Nov 1, 2005

Last updated

Jun 25, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark Dalley

Title

Ceo

Phone

(541) 881-7020

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1130803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1750372579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 SW 9TH ST",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979142639",
            "telephone_number": "541-881-7020",
            "fax_number": "541-881-7186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 NW 16TH ST",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192271",
            "telephone_number": "208-452-6851",
            "fax_number": "541-881-7156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINICAN HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-01",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "DALLEY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-881-7020"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "00189759321500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8053332-00",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF OREGON",
            "identifier": "X-009702000",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134054",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCID GROUP",
            "identifier": "E8340",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ciera Daley, PA-C
• Kyle Daron, PHARMD
• Abby Lynn Davis
• Brandon Scott Denney, M.D.
• Michelle F Devoe, D.O.
• Misty Dove
• Todd Michael Dunaway, DO
• Michael Allen Duncan, DC
• Ellen Dutcher, FNP
• Luann Dunn Dyer, LCPC

• Family Medicine Physician in Fruitland, ID
• Providers in Fruitland, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.