NPIMap

Organization Active NPI

Idaho Dept of Health & Welfare Reg 6 CMH Poc Clinic

  • Adolescent and Children Mental Health Clinic/Center
  • Pocatello, ID
National Provider Identifier
1780715045
Registry record updated Oct 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
IDAHO DEPT OF HEALTH & WELFARE REG 6 CMH POC CLINIC
Practice address
421 Memorial Dr
Pocatello, ID 83201-4008
Phone
(208) 234-7900
Fax
(208) 236-6328
NPI assigned
Mar 8, 2007
Last updated
Oct 22, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2010

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

Authorized official

Name
Ritchie Weers
Title
Clinical Supervisor
Phone
(208) 234-7900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU Primary

Addresses

Primary practice location

421 Memorial Dr
Pocatello, ID 83201-4008

Mailing address

421 Memorial Dr
Pocatello, ID 83201-4008
Phone (208) 234-7900

Other identifiers 3

IdentifierTypeStateIssuer
8073651MedicaidID
000010019402OtherIDBLUE SHIELD
HW157OtherIDBLUE 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": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287705600000",
    "number": "1780715045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014008",
            "telephone_number": "208-234-7900",
            "fax_number": "208-236-6328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014008",
            "telephone_number": "208-234-7900",
            "fax_number": "208-236-6328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DEPT OF HEALTH & WELFARE REG 6 CMH POC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2010-10-22",
        "status": "A",
        "authorized_official_last_name": "WEERS",
        "authorized_official_first_name": "RITCHIE",
        "authorized_official_title_or_position": "CLINICAL SUPERVISOR",
        "authorized_official_telephone_number": "208-234-7900"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8073651",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010019402",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "HW157",
            "state": "ID"
        }
    ],
    "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 Oct 22, 2010; 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.