STAR MEDICAL CENTER PC NPI 1508918244

NPI Information

  • NPI: 1508918244
  • Provider Name: STAR MEDICAL CENTER PC
  • Classification: Registered Nurse - 163WG0000X
  • Specialization: General Practice
  • Entity Type: Organization
  • Address: 9858 W STATE ST
    STAR, ID
    ZIP 83669
  • Phone: (208) 286-0666

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NPI Details

STAR MEDICAL CENTER PC is a general practice registered nurse in Star, ID. STAR MEDICAL CENTER PC NPI is 1508918244. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

9858 W STATE ST
STAR, ID
ZIP 83669-210
Phone: (208) 286-0666
Fax: (208) 286-0565

The provider's authorized official is Elmer G Dodge .
The authorized official title is President Owner and has the following contact phone number (208) 286-0666.

The enumeration date for this NPI number is 1/16/2007 and was last updated on 5/14/2013.

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
1163WG0000XRegistered NurseGeneral PracticeYes

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
18L030OTHERIDAHOBLUE CROSS OF ID
21379318MEDICARE ID-TYPE UNSPECIFIEDIDAHO
3807071100MEDICAIDIDAHO

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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