NPIMap

Organization Active NPI

Pocatello Health Services, LLC

  • Cardiovascular Disease Physician
  • Pocatello, ID
National Provider Identifier
1992713432
Registry record updated Nov 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
POCATELLO HEALTH SERVICES, LLC
Practice address
777 Hospital Way BLDG a
Ste. 101
Pocatello, ID 83201-2753
Phone
(208) 234-2001
Fax
(208) 232-2195
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2011

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

Authorized official

Name
Mr. John Abreu
Title
Cfo
Phone
(208) 239-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

777 Hospital Way BLDG a
Ste. 101
Pocatello, ID 83201-2753

Mailing address

PO Box 4168
Pocatello, ID 83205-4168
Phone (208) 234-2001

Other identifiers 1

IdentifierTypeStateIssuer
002507000MedicaidID

Other names 1

  • POCATELLO CARDIOLOGY ASSOCIATES Other name

National Provider Directory

National Provider Directory
Tax ID family
Isu Family Medicine6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

777 Hospital Way
Bldg A
Pocatello, ID 83201
Phone (208) 234-2001

120 N 12th Ave
Ste 4
Pocatello, ID 83201
Phone (208) 234-2001

Practitioners & affiliated clinicians

Practitioners 3

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": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320624000000",
    "number": "1992713432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4168",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832054168",
            "telephone_number": "208-234-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY BLDG A",
            "address_2": "STE. 101",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012753",
            "telephone_number": "208-234-2001",
            "fax_number": "208-232-2195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POCATELLO HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2011-11-07",
        "status": "A",
        "authorized_official_last_name": "ABREU",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "208-239-1000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002507000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "POCATELLO CARDIOLOGY ASSOCIATES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Nov 7, 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.