PAYETTE LAKES MEDICAL CLINIC, PA (NPI# 1255462263) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255462263 |
| Entity Type | Organization |
| Organization Name | PAYETTE LAKES MEDICAL CLINIC, PA |
| Practice Address |
211 Forest Street Mccall ID 83638 |
| Mailing Address |
Po Box 1047 Mccall ID 83638-1047 |
| Practice Telephone | 2086342225 |
| Practice Fax Number | 2086347212 |
| Mailing Telephone | 2086342225 |
| Mailing Fax Number | 2086347212 |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2008-03-11 |
| Authorized Official Name | JACQUELINE R. BRUNS (VP - PHYSICIAN SERVICES) |
| Authorized Official Telephone | 2086344061 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE CROSS | 8934-2 | 01 |
| ID | BLUE SHIELD | 000010006343 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902937196 | Payette Lakes Medical Clinic, Pa | Clinic/Center | 454 Rosebury Road, Suite 103, Donnelly, ID 83615 | 2007-03-08 |
| 1881725331 | Payette Lakes Medical Clinic, Pa | Clinic/Center | 101 Council Avenue, Suite C, Council, ID 83612 | 2007-03-08 |
| 1922139468 | Payette Lakes Medical Clinic, Pa | Clinic/Center | 320 Virginia Avenue, New Meadows, ID 83654 | 2007-03-08 |
| Street Address |
211 FOREST STREET |
| City | MCCALL |
| State | ID |
| Zip Code | 83638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265454276 | Todd James Arndt | Emergency Medicine | 211 Forest Street, Mccall, ID 83686 | 2006-07-25 |
| 1376722934 | Ihc, P.a. | Orthopaedic Surgery | 211 Forest Street, Mccall, ID 83638 | 2007-10-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255897708 | Seanne Jo Safaii | Dietitian, Registered | 1100 Heaven's Gate Ct. #1910, Mccall, ID 83638 | 2019-02-20 |
| 1053881284 | Debra Ann Jones Yensen | Counselor | 1242 Herrick Street N, Mccall, ID 83638 | 2018-11-30 |
| 1306369681 | Cheyene Joseph Nickerson | Pharmacist | 132 East Lake Street, Mccall, ID 83638 | 2017-07-19 |
| 1669923892 | Amy Leigh Forkan | Massage Therapist | 301 E Park St., Mccall, ID 83638 | 2016-10-24 |
| 1770982597 | Rachel L Smith | Acupuncturist | 106 E. Park St, Suite 102, Mc Call, ID 83638 | 2014-08-18 |
| 1275944498 | Central Idaho Counseling, Pllc | Social Worker | 125 Commerce St., Suite B, Mccall, ID 83638 | 2014-05-09 |
| 1548690829 | Sze Wan Chan | Pharmacist | 1001 North 2nd Street, Mccall, ID 83638 | 2013-11-22 |
| 1467882274 | Tamara Nagoda | Speech-Language Pathologist | 304 Edgewater Circle, Mccall, ID 83638 | 2013-11-14 |
| 1457537896 | Thomas L Moore | Counselor | 310 E. Lake St., Tom Moore, Mccall, ID 83638 | 2008-01-16 |
| 1659581585 | Barbara Gail Norton | Social Worker | 125 Commerce St, Suite B, Mccall, ID 83638 | 2007-05-22 |
| Find all providers in zip 83638 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 1275186835 | Bella Family Healthcare & Aesthetics | Clinic/Center | 1545 E Leighfield Dr Ste 100, Meridian, ID 83646-5371 | 2019-07-22 |
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| 1235618331 | Healthworks Med Group of Colorado P C | Clinic/Center | 126 E 21st St, Burley, ID 83318-2551 | 2018-08-09 |
| 1427537927 | Gem State Family Health Care Pllc | Clinic/Center | 496 Shoup Ave W Ste E, Twin Falls, ID 83301-5043 | 2018-08-07 |
| 1700379682 | Vera Whole Health, Wa PC | Clinic/Center | 219 Phil Meador Ave, Pocatello, ID 83202 | 2018-06-14 |
| 1073031118 | Clover Creek Medical | Clinic/Center | 175 North Main Street, Bloomington, ID 83223-8322 | 2017-09-08 |
| 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.