PHS MD #2 LLC NPI 1760719454

NPI Information

NPI: 1760719454
Provider Name: PHS MD #2, LLC

Other Name: PORTNEUF MEDICAL PRACTICES

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 13D0520280

Address:
651 MEMORIAL DR
POCATELLO, ID
ZIP 83201
Phone: (208) 239-2110
Get Directions

PHS MD #2, LLC is a multi-specialty clinic center in Pocatello, ID. PHS MD #2, LLC NPI is 1760719454. The provider is registered as an organization entity type.
The provider Other Name Is Portneuf Medical Practices.

The provider's business location address is:

651 MEMORIAL DR
POCATELLO, ID
ZIP 83201-071
Phone: (208) 239-2110
Fax: (208) 239-2145

The provider's authorized official is John Abreu .
The authorized official title is Cfo and has the following contact phone number (208) 239-2110.

The CLIA number assigned to this NPI record is 13D0520280 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/17/2009 and was last updated on 3/2/2010.

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	261QM1300X	Clinic/Center	Multi-Specialty		IDAHO	Yes

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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