NPIMap

Organization Active NPI

Phil Waggoner

  • Addiction (Substance Use Disorder) Counselor
  • Lewiston, ID
National Provider Identifier
1871651422
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
138 Issued in ID
Legal business name
PHIL WAGGONER
Practice address
1720 18TH Ave
Lewiston, ID 83501-4047
Phone
(208) 746-4097
Fax
(208) 746-2294
NPI assigned
Dec 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Dana K Boyd
Title
Business Ofc Manager Owner
Phone
(208) 746-4097

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YA0400X 138 ID Primary

Addresses

Primary practice location

1720 18TH Ave
Lewiston, ID 83501-4047

Mailing address

1720 18TH Ave
Lewiston, ID 83501
Phone (208) 746-4097

Other names 1

  • Riverside Recovery Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Phil Waggoner2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871651422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 18TH AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "83501",
            "telephone_number": "208-746-4097",
            "fax_number": "208-746-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 18TH AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014047",
            "telephone_number": "208-746-4097",
            "fax_number": "208-746-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHIL WAGGONER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOYD",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "BUSINESS OFC MANAGER OWNER",
        "authorized_official_telephone_number": "208-746-4097",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ID",
            "license": "138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lewiston, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.