NPIMap

Organization Active NPI

Upper Valley Community Health Services Inc

Doing business as Grand Peaks Pharmacy

  • Federally Qualified Health Center (FQHC)
  • Saint Anthony, ID
National Provider Identifier
1831721398
Registry record updated May 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UPPER VALLEY COMMUNITY HEALTH SERVICES INC
Doing business as
Grand Peaks Pharmacy
Practice address
335 E Main St Ste 4
Saint Anthony, ID 83445-1546
Phone
(208) 624-8300
Fax
(208) 624-4114
NPI assigned
Feb 12, 2020
Last updated
May 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2024

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

Authorized official

Name
Lori K Sessions
Title
Ceo
Phone
(208) 356-4900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

335 E Main St Ste 4
Saint Anthony, ID 83445-1546

Mailing address

PO Box 18
Saint Anthony, ID 83445-0018
Phone (208) 356-4900

Other names 1

  • GRAND PEAKS PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201002002019 ID Part B Supplier - Pharmacy 4385725282 2 other NPIs on this enrollment
Practice locations: Idaho Falls, ID; Rexburg, ID; Saint Anthony, ID

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Upper Valley Community Health Services11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Upper Valley Community Health Services IncSaint Anthony, ID, CCN 131836 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2007
Grand Peaks Medical Or Grand Peaks Behavioral HealthRexburg, ID, CCN 131868 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control (100%)		 Feb 8, 2008
Feb 8, 2008
Grand Peaks Behavioral HealthSaint Anthony, ID, CCN 131878 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 4, 2024
Upper Valley Community Health Services IncIdaho Falls, ID, CCN 131044 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2024
Grand Peaks Medical Behavioral HealthDubois, ID, CCN 131051 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Nov 1, 2007

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1581465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716249600000",
    "number": "1831721398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18",
            "city": "SAINT ANTHONY",
            "state": "ID",
            "postal_code": "834450018",
            "telephone_number": "208-356-4900",
            "fax_number": "208-624-4112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 E MAIN ST STE 4",
            "city": "SAINT ANTHONY",
            "state": "ID",
            "postal_code": "834451546",
            "telephone_number": "208-624-8300",
            "fax_number": "208-624-4114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER VALLEY COMMUNITY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-12",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A",
        "authorized_official_last_name": "SESSIONS",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-356-4900"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRAND PEAKS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Anthony, ID

Sources for this page

Verify at the official NPI Registry.