VISTA HEALTHCARE PC NPI 1720502370

NPI Information

NPI: 1720502370
Provider Name: VISTA HEALTHCARE PC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 13D2135696

Address:
556 TREJO ST STE B
REXBURG, ID
ZIP 83440
Phone: (208) 351-6981
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VISTA HEALTHCARE PC is a primary care clinic center in Rexburg, ID. VISTA HEALTHCARE PC NPI is 1720502370. The provider is registered as an organization entity type.

The provider's business location address is:

556 TREJO ST STE B
REXBURG, ID
ZIP 83440-626
Phone: (208) 351-6981

The provider's authorized official is Rachelle Jones .
The authorized official title is President and has the following contact phone number (208) 881-0902.

The CLIA number assigned to this NPI record is 13D2135696 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/26/2017 and was last updated on 11/17/2017.

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
1	261QP2300X	Clinic/Center	Primary Care	NP-914A	IDAHO	Yes
2	363L00000X	Nurse Practitioner		NP-914A	IDAHO	No
3	363LF0000X	Nurse Practitioner	Family	NP-914A	IDAHO	No
4	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	NP-914A	IDAHO	No
5	363LW0102X	Nurse Practitioner	Women's Health	NP-914A		No
6	363LX0001X	Nurse Practitioner	Obstetrics & Gynecology			No

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
1	1982830345	MEDICAID	IDAHO

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

NPI Synchronization or Removal

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