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CENTER FOR LIFETIME HEALTH NPI 1689744963


NPI Information

NPI: 1689744963
Provider Name: CENTER FOR LIFETIME HEALTH

Doing Business As: COLLEEN SHACKELFORD, LLC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 13D1033411

Address:
300 E BANNOCK ST
BOISE, ID
ZIP 83712
Phone: (208) 342-7400
Get Directions

CENTER FOR LIFETIME HEALTH is a family medicine in Boise, ID. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CENTER FOR LIFETIME HEALTH NPI is 1689744963. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Colleen Shackelford, Llc.

The provider's business location address is:

300 E BANNOCK ST
BOISE, ID
ZIP 83712
Phone: (208) 342-7400
Fax: (208) 342-1879

The provider's authorized official is Colleen Shackelford .
The authorized official title is Owner and has the following contact phone number (208) 342-7400.

The CLIA number assigned to this NPI record is 13D1033411 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 11/8/2006 and was last updated on 7/25/2023.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineM5741IDAHOYes

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

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