STATE OF IDAHO (NPI# 1063576445) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063576445 |
| Entity Type | Organization |
| Organization Name | STATE OF IDAHO |
| Other Organization Name | SOUTHEASTERN DISTRICT HEALTH DEPARTMENT |
| Practice Address |
1901 Alvin Ricken Dr Pocatello ID 83201-2727 |
| Practice Telephone | 2082339080 |
| Practice Fax Number | 2084789297 |
| Mailing Telephone | 2082339080 |
| Mailing Fax Number | 2084789297 |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2008-06-30 |
| Authorized Official Name | MR. EDWARD A. MARUGG (DIRECTOR) |
| Authorized Official Telephone | 2082339080 |
| Authorized Official Credential | R.E.H.S |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251K00000X | Public Health or Welfare | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 002832700 | 05 | |
| ID | 002834600 | 05 | |
| ID | 002470300 | 05 |
| Other Name | Type Code |
|---|---|
| Southeastern District Health Department | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962755868 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1182 West Kyler Ave, Hayden, ID 83835 | 2012-10-17 |
| 1316063787 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-21 |
| 1750442315 | State of Idaho | Pharmacy | 700 East Alice Street, Blackfoot, ID 83221 | 2006-12-13 |
| 1801833454 | State of Idaho | Optometrist | 120 S Cole Rd, Suite 120 - Bldg 3, Boise, ID 83709-0932 | 2006-06-01 |
| 1649277393 | State of Idaho | Home Health | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2005-07-07 |
| 1790131027 | State of Idaho | Community/Behavioral Health | 1720 N Westgate Dr, Boise, ID 83704-7164 | 2016-05-05 |
| 1053615260 | State of Idaho | Psychologist | 700 E Alice St, Blackfoot, ID 83221-4925 | 2011-01-03 |
| 1538285481 | State of Idaho | Optometrist | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| 1588780449 | State of Idaho | Podiatrist | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| 1265558019 | State of Idaho | Family Medicine | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| Street Address |
1901 ALVIN RICKEN DR |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-2727 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649277393 | State of Idaho | Home Health | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2005-07-07 |
| 1457822652 | Shaunna Rae Kramer | Nurse Practitioner | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2018-12-16 |
| 1023250966 | Southeastern District Health Department | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2009-03-24 |
| 1750526216 | Southeastern District Health Department | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2008-12-11 |
| 1396919916 | Southeastern District Health Dept. | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2008-04-15 |
| 1235260829 | State of Idaho | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2007-03-08 |
| 1811028319 | State of Idaho | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2007-03-08 |
| 1821129420 | State of Idaho | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2007-03-08 |
| 1740346527 | Christine Fuhrman Mladenka | Nurse Practitioner | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2006-12-28 |
| 1154481224 | Lindsey Scott | Physician Assistant | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2006-12-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 251K00000X |
| Grouping | Agencies |
| Classification | Public Health or Welfare |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023250966 | Southeastern District Health Department | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2009-03-24 |
| 1750526216 | Southeastern District Health Department | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2008-12-11 |
| 1396919916 | Southeastern District Health Dept. | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2008-04-15 |
| 1235260829 | State of Idaho | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2007-03-08 |
| 1811028319 | State of Idaho | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2007-03-08 |
| 1821129420 | State of Idaho | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2007-03-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154426104 | Eastern Idaho Public Health District | Public Health or Welfare | 1250 Hollipark Dr, Idaho Falls, ID 83401-6217 | 2006-09-14 |
| 1841212933 | Public Health District 1 | Public Health or Welfare | 114 W Riverside Ave, Kellogg, ID 83837-2351 | 2006-07-24 |
| 1639116627 | Counseling Center of Southeast Idaho | Public Health or Welfare | 496 A St, Idaho Falls, ID 83402-3617 | 2006-05-31 |
| 1598763849 | Power County Hospital District | Public Health or Welfare | 502 Tyhee Ave, American Falls, ID 83211-1224 | 2005-07-11 |
| 1992239172 | Power County Hospital District | Public Health or Welfare | 50 South Main St, Aberdeen, ID 83210 | 2017-04-14 |
| 1588038616 | Carmen Hernandez Radford | Public Health or Welfare | 3652 Washington Pkwy, Idaho Falls, ID 83404-7573 | 2015-12-01 |
| 1760729206 | Southwest District Health | Public Health or Welfare | 13307 Miami Ln, Caldwell, ID 83607-4701 | 2013-01-03 |
| 1215177993 | North Central District Health Department | Public Health or Welfare | 215 10th St, Lewiston, ID 83501-1910 | 2009-02-20 |
| 1689820375 | Southwest District Health | Public Health or Welfare | 13307 Miami Ln, Caldwell, ID 83607-4701 | 2008-08-13 |
| 1205036001 | District Seven Health Department | Public Health or Welfare | 254 E St, Idaho Falls, ID 83402-3527 | 2007-07-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.