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 | | 24 | 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 | MUTUAL OF OMAHA |
| 2 | 8041298 | MEDICAID | IDAHO | |
| 3 | ========= | OTHER | IDAHO | PHYSICIALNS MUTUAL |
| 4 | ========= | OTHER | IDAHO | EQUITABLE LIFE |
| 5 | ========= | OTHER | IDAHO | HEART 'N HOME |
| 6 | 135015 | MEDICARE OSCAR/CERTIFICATION | | |
| 7 | ========= | OTHER | IDAHO | AMERICAN REPUBLIC INS CO |
| 8 | ========= | OTHER | IDAHO | BANKERS LIFE & CASUALTY |
| 9 | ========= | OTHER | IDAHO | DESERET MUTUAL |
| 10 | ========= | OTHER | IDAHO | BLUE CROSS BLUE SIELD OF |
| 11 | ========= | OTHER | IDAHO | REGENCE BC/BS OF UT |
| 12 | ========= | OTHER | IDAHO | ODS HEALTH PLAN |
| 13 | ========= | OTHER | IDAHO | APWU |
| 14 | 01156 | OTHER | IDAHO | BLUE CROSS OF IDAHO |
| 15 | ========= | OTHER | IDAHO | AARP HEALTHCARE |
| 16 | ========= | OTHER | IDAHO | AETNA INS |
| 17 | ========= | OTHER | IDAHO | COMBINED INS CO OF AMERIC |
| 18 | 000010013110 | OTHER | IDAHO | REGENCE BLUE SHIELD OF ID |
| 19 | ========= | OTHER | IDAHO | FEDERAL BLUE CROSS |
