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FAMILY PRACTICE GROUP P.A. NPI 1205869310


NPI Information

NPI: 1205869310
Provider Name: FAMILY PRACTICE GROUP, P.A.

Doing Business As: INTERMOUNTAIN MEDICAL CLINIC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 13D0520334

Address:
1951 BENCH RD
SUITE B
POCATELLO, ID
ZIP 83201
Phone: (208) 238-1000
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FAMILY PRACTICE GROUP, P.A. is a family medicine in Pocatello, 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. FAMILY PRACTICE GROUP, P.A. NPI is 1205869310. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Intermountain Medical Clinic.

The provider's business location address is:

1951 BENCH RD
SUITE B
POCATELLO, ID
ZIP 83201-073
Phone: (208) 238-1000
Fax: (238) 238-0009

The provider's authorized official is Shelly Stranski .
The authorized official title is Administrator and has the following contact phone number (208) 238-1000.

The CLIA number assigned to this NPI record is 13D0520334 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 7/9/2006 and was last updated on 5/28/2015.


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 AssistantNo
2207N00000XDermatologyNo
3207Q00000XFamily 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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11371581MEDICARE 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: 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.