MERCY PHYSICIAN GROUP INC. NPI 1104972983

NPI Information

  • NPI: 1104972983
  • Provider Name: MERCY PHYSICIAN GROUP INC.
  • Classification: Family Medicine - 207QA0505X
  • Specialization: Adult Medicine
  • Entity Type: Organization
  • Address: 1512 12TH AVE RD
    NAMPA, ID
    ZIP 83686
  • Phone: (208) 463-5000

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NPI Details

MERCY PHYSICIAN GROUP INC. is an adult medicine family medicine in Nampa, ID. The provider is the National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code. MERCY PHYSICIAN GROUP INC. NPI is 1104972983. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1512 12TH AVE RD
NAMPA, ID
ZIP 83686-008
Phone: (208) 463-5000
Fax: (208) 463-5578

The provider's authorized official is B Lannie Checketts .
The authorized official title is Chief Financial Officer and has the following contact phone number (208) 463-5531.

The enumeration date for this NPI number is 1/26/2007 and was last updated on 4/14/2008.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RI0011XInternal MedicineInterventional CardiologyNo
2208600000XSurgeryNo
3207QA0000XFamily MedicineAdolescent MedicineNo
4207QG0300XFamily MedicineGeriatric MedicineNo
5207QS0010XFamily MedicineSports MedicineNo
6207RC0000XInternal MedicineCardiovascular DiseaseNo
7207QA0505XFamily MedicineAdult MedicineYes

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
11366549MEDICARE 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: 3/30/2025

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