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PETRIE WHITE FAMILY MEDICINE OF IDAHO NPI 1447629555


NPI Information

NPI: 1447629555
Provider Name: PETRIE WHITE FAMILY MEDICINE OF IDAHO

Doing Business As: EMMETT FAMILY MEDICINE AND DIRECT PRIMARY CARE

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 13D2103854

Address:
2001 E QUAIL RUN RD
EMMETT, ID
ZIP 83617
Phone: (208) 365-7131
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PETRIE WHITE FAMILY MEDICINE OF IDAHO is a family medicine in Emmett, 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. PETRIE WHITE FAMILY MEDICINE OF IDAHO NPI is 1447629555. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Emmett Family Medicine And Direct Primary Care.

The provider's business location address is:

2001 E QUAIL RUN RD
EMMETT, ID
ZIP 83617-059
Phone: (208) 365-7131
Fax: (208) 365-4464

The provider's authorized official is Ryan Earl White .
The authorized official title is Clinic Administrator and has the following contact phone number (208) 365-7131.

The CLIA number assigned to this NPI record is 13D2103854 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/18/2015 and was last updated on 1/12/2016.


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 MedicineM7802IDAHOYes

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
1805196400MEDICAIDIDAHO
2H36248MEDICARE UPINIDAHO
311063077MEDICARE 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: 5/5/2024

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