NPIMap

Organization Active NPI

Psychiatry-Ect, PLLC

  • Psychiatry Physician
  • Pocatello, ID
National Provider Identifier
1972808806
Registry record updated Jan 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
M-9600 Issued in ID
Legal business name
PSYCHIATRY-ECT, PLLC
Practice address
285 Vista Dr
Suite D
Pocatello, ID 83201
Phone
(208) 233-8344
Fax
(208) 233-6983
NPI assigned
Jan 25, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2011

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

Authorized official

Name
Dr. Predrag V Gligorovic, M.D.
Title
Owner
Phone
(208) 233-8344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X M-9600 ID Primary

Addresses

Primary practice location

285 Vista Dr
Suite D
Pocatello, ID 83201

Mailing address

285 Vista Dr
Suite D
Pocatello, ID 83201
Phone (208) 233-8344

National Provider Directory

National Provider Directory

Locations

285 Vista Dr
Ste D
Pocatello, ID 83201
Phone (208) 232-6060

NPI Registry JSON

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

{
    "created_epoch": "1295913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295913600000",
    "number": "1972808806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 VISTA DR",
            "address_2": "SUITE D",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "83201",
            "telephone_number": "208-233-8344",
            "fax_number": "208-233-6983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 VISTA DR",
            "address_2": "SUITE D",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "83201",
            "telephone_number": "208-233-8344",
            "fax_number": "208-233-6983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRY-ECT, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-25",
        "last_updated": "2011-01-25",
        "status": "A",
        "authorized_official_last_name": "GLIGOROVIC",
        "authorized_official_first_name": "PREDRAG",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-233-8344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "M-9600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; 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.