MAGIC VALLEY MEDICINE PLLC NPI 1174939383

NPI Information

NPI: 1174939383
Provider Name: MAGIC VALLEY MEDICINE PLLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 13D2112426

Address:
844 WASHINGTON ST N STE 400
TWIN FALLS, ID
ZIP 83301
Phone: (208) 734-0000
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MAGIC VALLEY MEDICINE PLLC is a family nurse practitioner in Twin Falls, ID. MAGIC VALLEY MEDICINE PLLC NPI is 1174939383. The provider is registered as an organization entity type.

The provider's business location address is:

844 WASHINGTON ST N STE 400
TWIN FALLS, ID
ZIP 83301-874
Phone: (208) 734-0000
Fax: (208) 735-5053

The provider's authorized official is Samuel H Barker .
The authorized official title is Sole Member and has the following contact phone number (208) 734-0000.

The CLIA number assigned to this NPI record is 13D2112426 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/8/2014 and was last updated on 7/11/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332B00000X	Durable Medical Equipment & Medical Supplies				No
2	363LF0000X	Nurse Practitioner	Family			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1174939383	MEDICAID	IDAHO
2	7369300001	OTHER		MEDICARE DME
3	20005523	MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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