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CLEARWATER MEDICAL CENTER PLLC NPI 1558452268


NPI Information

NPI: 1558452268
Provider Name: CLEARWATER MEDICAL CENTER PLLC

Doing Business As: CLEARWATER MEDICAL CLINIC

Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
1522 17TH ST
LEWISTON, ID
ZIP 83501
Phone: (208) 743-8416
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CLEARWATER MEDICAL CENTER PLLC is a family nurse practitioner in Lewiston, ID. CLEARWATER MEDICAL CENTER PLLC NPI is 1558452268. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Clearwater Medical Clinic.

The provider's business location address is:

1522 17TH ST
LEWISTON, ID
ZIP 83501-652
Phone: (208) 743-8416
Fax: (208) 743-4642

The provider's authorized official is Celso R Chavez .
The authorized official title is Owner Physician and has the following contact phone number (208) 743-8416.

The enumeration date for this NPI number is 9/27/2006 and was last updated on 12/16/2008.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineA87025IDAHONo
2363LF0000XNurse PractitionerFamilyNP740AIDAHONo
3363LF0000XNurse PractitionerFamilyNP751AIDAHONo
4363LF0000XNurse PractitionerFamilyNP372AIDAHONo
5363LF0000XNurse PractitionerFamilyNP388AIDAHONo
6363LF0000XNurse PractitionerFamilyNP390AIDAHONo
7363LF0000XNurse PractitionerFamilyNP361AYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11372186MEDICARE ID-TYPE UNSPECIFIEDIDAHOGROUP PROVIDER NUMBER
20466670001MEDICARE NSCIDAHO

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.