NPI |
1417246158 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
REGIONAL PHYSICIAN SERVICES OF IDAHO, PC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
1105 2ND ST S STE 100 |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Business Practice Location Address City Name |
NAMPA |
Other name by which the organization provider is or has been known. |
Provider Business Practice Location Address State Name |
ID |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider Business Practice Location Address Postal Code |
836513911 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Provider Business Practice Location Address Telephone Number |
4808621677 |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
4807187643 |
The State code in the location of the provider
being identified. |
Provider Enumeration Date |
4/4/2011 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Last Update Date |
12/11/2019 |
The country code in the location address of the provider being identified. |
Authorized Official Last Name |
ALVAREZ |
The telephone number associated with the location address of the provider being identified. |
Authorized Official First Name |
VICTORIA |
The fax number associated with the location
address of the provider being identified. |
Authorized Official Title or Position |
DIRECTOR, CREDENTIALING |
The date the provider was assigned a unique identifier (assigned an NPI). |
Authorized Official Telephone Number |
4808621695 |
The date that a record was last updated or changed. |
Healthcare Provider Taxonomy Code 1 |
363L00000X |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The first name of the authorized official. |
Is Organization Subpart |
N |
The middle name of the authorized official. |
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
The title or position of the authorized official. |