NPIMap

Organization Active NPI

Keith E Davis

Doing business as Shoshone Family Medical Center

  • Rural Health Clinic/Center
  • Shoshone, ID
National Provider Identifier
1972673218
Registry record updated Mar 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KEITH E DAVIS
Doing business as
Shoshone Family Medical Center
Practice address
113 S Apple St
Shoshone, ID 83352-5287
Phone
(208) 886-2222
NPI assigned
Nov 8, 2006
Last updated
Mar 8, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2012

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

Authorized official

Name
Keith E Davis, MDNPI 1043277635
Title
Owner
Phone
(208) 886-2224

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

113 S Apple St
Shoshone, ID 83352-5287

Mailing address

PO Box 609
Shoshone, ID 83352-0609

Other identifiers 1

IdentifierTypeStateIssuer
806290300MedicaidID

Other names 1

  • Shoshone Family Medical Center Doing business as

National Provider Directory

National Provider Directory

Locations

113 S Apple St
Shoshone, ID 83352
Phone (208) 886-2224

Practitioners & affiliated clinicians

Practitioners 9

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": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331164800000",
    "number": "1972673218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 609",
            "city": "SHOSHONE",
            "state": "ID",
            "postal_code": "833520609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 S APPLE ST",
            "city": "SHOSHONE",
            "state": "ID",
            "postal_code": "833525287",
            "telephone_number": "208-886-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH E DAVIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2012-03-08",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-886-2224",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806290300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shoshone Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shoshone, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; 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.