Endobiogenic Integrative Medical Center

Primary specialty

NutritionistTaxonomy code 133N00000X

Legal business name

ENDOBIOGENIC INTEGRATIVE MEDICAL CENTER

Practice address

357 W Center St Ste 204
Pocatello, ID 83204-3236

Phone

(208) 478-8400

Fax

(208) 232-6018

NPI assigned

Mar 23, 2009

Last updated

Mar 23, 2009By 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

Mrs. Annette Nica Davis, C.N.

Title

Administrator

Phone

(208) 478-8400

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Dellisa Dawn Eddington, NP-C

  • Family Nurse Practitioner
  • Pocatello, ID
  • NPI 1356812945
  NPD (past)

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

{
    "created_epoch": "1237766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237766400000",
    "number": "1821239781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 W CENTER ST STE 204",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832043236",
            "telephone_number": "208-478-8400",
            "fax_number": "208-232-6018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 W CENTER ST STE 204",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832043236",
            "telephone_number": "208-478-8400",
            "fax_number": "208-232-6018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDOBIOGENIC INTEGRATIVE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-23",
        "last_updated": "2009-03-23",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_middle_name": "NICA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-478-8400",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "C.N."
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Elizabeth Ellsworth
• Brooke Elzey, PA-C
• Emeritus Corporation (Brookdale Pocatello)
• Gregory Scott Emfield, D.O
• Empower Counseling, Coaching and Consulting, LLC
• Endoscopy Center, LLC
• Joseph Alfred Enfonde, MD
• Allen A. Eng, M.D.
• Enhance DME LLC
• Scott Entrikin, SUDA

• Nutritionist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Nutritionist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2009; 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.