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DOCTORS CLINIC OF ELMORE COUNTY PLLC NPI 1063578664


NPI Information

NPI: 1063578664
Provider Name: DOCTORS CLINIC OF ELMORE COUNTY PLLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 13D0938420

Address:
2000 AMERICAN LEGION BLVD
MOUNTAIN HOME, ID
ZIP 83647
Phone: (208) 587-1500
Get Directions

DOCTORS CLINIC OF ELMORE COUNTY PLLC is a family medicine in Mountain Home, 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. DOCTORS CLINIC OF ELMORE COUNTY PLLC NPI is 1063578664. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

2000 AMERICAN LEGION BLVD
MOUNTAIN HOME, ID
ZIP 83647-138
Phone: (208) 587-1500
Fax: (208) 587-3180

The provider's authorized official is Layne D Roberts .
The authorized official title is Physician and has the following contact phone number (208) 587-1500.

The CLIA number assigned to this NPI record is 13D0938420 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 12/28/2006 and was last updated on 2/25/2008.


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
1363A00000XPhysician AssistantPA-265IDAHONo
2207Q00000XFamily MedicineO-91IDAHOYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1D17306MEDICARE UPINIDAHO
21378082MEDICARE ID-TYPE UNSPECIFIEDIDAHO

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: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.