TWO RIVERS MEDICAL CLINIC PA NPI 1376662486

NPI Information

  • NPI: 1376662486
  • Provider Name: TWO RIVERS MEDICAL CLINIC, PA
  • Classification: Clinic/Center - 261QR1300X
  • Specialization: Rural Health
  • Entity Type: Organization
  • CLIA Number: 13D0521438
  • Address: 683 E 3RD ST
    WEISER, ID
    ZIP 83672
  • Phone: (208) 549-0211

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NPI Details

TWO RIVERS MEDICAL CLINIC, PA is a rural health clinic center in Weiser, ID. TWO RIVERS MEDICAL CLINIC, PA NPI is 1376662486. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

683 E 3RD ST
WEISER, ID
ZIP 83672-248
Phone: (208) 549-0211
Fax: (208) 549-0104

The provider's authorized official is Tony Edmondson .
The authorized official title is Clinic Administrator and has the following contact phone number (208) 549-0211.

The CLIA number assigned to this NPI record is 13D0521438 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 3/28/2007 and was last updated on 4/12/2016.

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
1207Q00000XFamily MedicineNo
2261QR1300XClinic/CenterRural HealthYes

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
11376662486MEDICAIDIDAHO
2805040300MEDICAIDIDAHO
3002756600MEDICAIDIDAHO
4002756300MEDICAIDIDAHO
51373810MEDICARE ID-TYPE UNSPECIFIEDIDAHO
61373819MEDICARE ID-TYPE UNSPECIFIEDIDAHO
7133836MEDICARE OSCAR/CERTIFICATIONIDAHO

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: 11/21/2025

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