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SNAKE RIVER PEDIATRICS PC NPI 1700269792


NPI Information

NPI: 1700269792
Provider Name: SNAKE RIVER PEDIATRICS, PC
Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
1100 NW 12TH ST
FRUITLAND, ID
ZIP 83619
Phone: (208) 452-6556
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SNAKE RIVER PEDIATRICS, PC is a rural health clinic center in Fruitland, ID. SNAKE RIVER PEDIATRICS, PC NPI is 1700269792. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1100 NW 12TH ST
FRUITLAND, ID
ZIP 83619-040
Phone: (208) 452-6556
Fax: (541) 216-6557

The provider's authorized official is Matthew Joseph Berria .
The authorized official title is President and has the following contact phone number (208) 740-4518.

The enumeration date for this NPI number is 7/8/2015 and was last updated on 8/16/2023.


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
1208000000XPediatricsPA000913OREGONNo
2261QR1300XClinic/CenterRural HealthPA000913OREGONYes

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
1500605243MEDICAIDOREGON
21902985740OTHERNPI

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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