NPIMap

Organization Active NPI

Brent Leavitt

  • Critical Access Hospital
  • Chubbuck, ID
National Provider Identifier
1851761464
Registry record updated Sep 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
BRENT LEAVITT
Practice address
4928 Pleasant View Dr
Chubbuck, ID 83202-1640
Phone
(208) 760-9416
NPI assigned
Sep 25, 2015
Last updated
Sep 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2015

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

Authorized official

Name
Brent R Leavitt, PA-CNPI 1740650548
Title
Owner
Phone
(208) 760-9416

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X ID Primary

Addresses

Primary practice location

4928 Pleasant View Dr
Chubbuck, ID 83202-1640

Mailing address

4928 Pleasant View Dr
Chubbuck, ID 83202-1640
Phone (208) 760-9416

Other names 1

  • maximum security inc Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443139200000",
    "number": "1851761464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4928 PLEASANT VIEW DR",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832021640",
            "telephone_number": "208-760-9416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4928 PLEASANT VIEW DR",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832021640",
            "telephone_number": "208-760-9416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENT LEAVITT",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-25",
        "last_updated": "2015-09-25",
        "status": "A",
        "authorized_official_last_name": "LEAVITT",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-760-9416",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "maximum security inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chubbuck, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2015; 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.