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 | 314000000X | Skilled Nursing Facility | | 34 | IDAHO | Yes |
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 | ========= | OTHER | IDAHO | AMER PIONEER LIFE |
| 2 | ========= | OTHER | IDAHO | BLUE CROSS OF CA |
| 3 | ========= | OTHER | IDAHO | AETNA US HEALTHCARE |
| 4 | ========= | OTHER | IDAHO | AMER INCOME LIFE INS |
| 5 | ========= | OTHER | IDAHO | APWU HEALTH PLAN |
| 6 | ========= | OTHER | IDAHO | BLUE CROSS OF OREGON |
| 7 | ========= | OTHER | IDAHO | CENTRAL STATES HEALTH OF |
| 8 | 01867 | OTHER | IDAHO | BLUE CROSS OF IDAHO |
| 9 | ========= | OTHER | IDAHO | BLUE CROSS FEDERAL |
| 10 | ========= | OTHER | IDAHO | EQUITABLE LIFE & CASUALTY |
| 11 | ========= | OTHER | IDAHO | ITT INDUSTRIES |
| 12 | ========= | OTHER | IDAHO | BLUE CROSS IBM EMPIRE |
| 13 | ========= | OTHER | IDAHO | FARMERS INSURANCE |
| 14 | 135095 | MEDICARE OSCAR/CERTIFICATION | | |
| 15 | ========= | OTHER | IDAHO | AARP |
| 16 | ========= | OTHER | IDAHO | BOISE MEMORIAL HOSPICE |
| 17 | 0029214 | MEDICAID | IDAHO | |
| 18 | 000010012586 | OTHER | IDAHO | BLUE SHIELD OF IDAHO |
| 19 | ========= | OTHER | IDAHO | BANKERS LIFE & CASUALTY |
| 20 | ========= | OTHER | IDAHO | GEHA/US GOVERNMENT |
