NPIMap

Organization Active NPI

Payette Lakes Medical Clinic, PA

  • Primary Care Clinic/Center
  • Council, ID
National Provider Identifier
1881725331
Registry record updated Mar 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PAYETTE LAKES MEDICAL CLINIC, PA
Practice address
101 Council Avenue
Suite C
Council, ID 83612
Phone
(208) 253-4915
Fax
(208) 253-4917
NPI assigned
Mar 8, 2007
Organization subpart
Yes
Parent organization
PAYETTE LAKES MEDICAL CLINIC, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2008

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

Authorized official

Name
Jacqueline R Bruns
Title
VP - Physician Services
Phone
(208) 634-4061

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

101 Council Avenue
Suite C
Council, ID 83612

Mailing address

PO Box 1047
McCall, ID 83638-1047
Phone (208) 634-2225

Other identifiers 2

IdentifierTypeStateIssuer
8G122OtherIDBC
000010139844OtherIDBS

Other names 1

  • Council Mountain Medical Clinic Other name

National Provider Directory

National Provider Directory
Part of
Payette Lakes Medical CL

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1205712000000",
    "number": "1881725331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1047",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836381047",
            "telephone_number": "208-634-2225",
            "fax_number": "208-634-7212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 COUNCIL AVENUE",
            "address_2": "SUITE C",
            "city": "COUNCIL",
            "state": "ID",
            "postal_code": "83612",
            "telephone_number": "208-253-4915",
            "fax_number": "208-253-4917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAYETTE LAKES MEDICAL CLINIC, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PAYETTE LAKES MEDICAL CLINIC, PA",
        "enumeration_date": "2007-03-08",
        "last_updated": "2008-03-17",
        "status": "A",
        "authorized_official_last_name": "BRUNS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "VP - PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "208-634-4061"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "8G122",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS",
            "identifier": "000010139844",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Council Mountain Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Council, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; 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.