CENTER STREET HEALTH CARE LLC NPI 1417104530

NPI Information

NPI: 1417104530
Provider Name: CENTER STREET HEALTH CARE LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
1553 E CENTER ST
POCATELLO, ID
ZIP 83201
Phone: (208) 233-9355
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CENTER STREET HEALTH CARE LLC is a family nurse practitioner in Pocatello, ID. CENTER STREET HEALTH CARE LLC NPI is 1417104530. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1553 E CENTER ST
POCATELLO, ID
ZIP 83201-135
Phone: (208) 233-9355
Fax: (208) 233-9300

The provider's authorized official is Cynthia Marie Rice .
The authorized official title is Owner/provider and has the following contact phone number (208) 233-9355.

The enumeration date for this NPI number is 8/20/2008 and was last updated on 9/30/2008.

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
1	363LF0000X	Nurse Practitioner	Family	NP252A	IDAHO	Yes

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
1	R94903	MEDICARE UPIN	IDAHO
2	004383300	MEDICAID	IDAHO

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

NPI Synchronization or Removal

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