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PEARL PRIMARY CARE PLLC NPI 1720561103


NPI Information

NPI: 1720561103
Provider Name: PEARL PRIMARY CARE PLLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
2705 E 17TH ST STE B
AMMON, ID
ZIP 83406
Phone: (208) 497-0566
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PEARL PRIMARY CARE PLLC is a family medicine in Ammon, 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. PEARL PRIMARY CARE PLLC NPI is 1720561103. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2705 E 17TH ST STE B
AMMON, ID
ZIP 83406-601
Phone: (208) 497-0566
Fax: (208) 346-7501

The provider's authorized official is Zakery Warren .
The authorized official title is Owner/director and has the following contact phone number (208) 346-7500.

The enumeration date for this NPI number is 9/11/2018 and was last updated on 9/11/2018.


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 MedicineYes

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
11848OTHERIDAHOCITY OF AMMON BUSINESS LICENSE

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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