ACTIVE FAMILY HEALTHCARE PLLC (NPI# 1063764462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063764462 |
| Entity Type | Organization |
| Organization Name | ACTIVE FAMILY HEALTHCARE PLLC |
| Practice Address |
919 W Canfield Ave Coeur D Alene ID 83815-9764 |
| Practice Telephone | 2087580560 |
| Practice Fax Number | 2087625424 |
| Mailing Telephone | 2087580560 |
| Mailing Fax Number | 2087625424 |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2020-06-23 |
| Authorized Official Name | DR. JENNIFER FLETCHER (OWNER NURSE PRACTIONER) |
| Authorized Official Telephone | 2087580560 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305R00000X | Preferred Provider Organization | Managed Care Organizations |
| Street Address |
919 W CANFIELD AVE |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83815-9764 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063454981 | Jennifer Fletcher | Nurse Practitioner | 919 W Canfield Ave, Coeur D Alene, ID 83815-9764 | 2006-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790133163 | Christine Lee Stanton | Speech-Language Pathologist | 3825 N. Blalock Drive, Coeur D'alene, ID 83815 | 2016-05-26 |
| 1578921961 | Kayla Wearne | Speech-Language Pathologist | 917 W Canfield Avenue, Coeur D'alene, ID 83815 | 2016-02-01 |
| 1770954794 | William Strong | Speech-Language Pathologist | 3902 Broken Arrow Rd, Coeur D Alene, ID 83815 | 2015-10-16 |
| 1235517079 | Denny Bordeaux | Emergency Medical Technician, Paramedic | 7294 Downing Lane, Coeur D Alene, ID 83815 | 2015-05-13 |
| 1689075657 | Barbara Campbell | Pharmacist | W 201 Neider Rd., Coeur D'alene, ID 83815 | 2014-09-10 |
| 1710313671 | Sean Cooper | Pharmacist | W. 201 Neider Rd., Coeur D' Alene, ID 83815 | 2013-09-23 |
| 1275871329 | Lake City Dental | Dentist | 6176 Government Way, Coeur D'alene, ID 83815 | 2013-01-24 |
| 1881972701 | A Better Personal Care Inc | In Home Supportive Care | 3115 N Government Way Ste 2, Coeur D'alene, ID 83815 | 2011-07-26 |
| 1013206895 | Robert Sperry | Pharmacist | 41650 W Maricopacg Hwy., Maricopa, AZ 83815 | 2011-04-01 |
| 1629304670 | Marciea W. Buckley | Social Worker | 109 Harrison Ave, Coeur D' Alene, ID 83815 | 2009-10-27 |
| Find all providers in zip 83815 | ||||
| Taxonomy Code | 305R00000X |
| Grouping | Managed Care Organizations |
| Classification | Preferred Provider Organization |
| A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720521719 | Advanced Chiropractic of Blackfoot | Preferred Provider Organization | 1395 Nw Main St, Blackfoot, ID 83221-3936 | 2016-11-23 |
| 1366811267 | Celebrate Life Wellness | Preferred Provider Organization | 7750 W Crestwood Dr, Boise, ID 83704-3000 | 2015-09-21 |
| 1326414673 | Douglas R. Schultz | Preferred Provider Organization | 2285 E 25th St, Idaho Falls, ID 83404-4724 | 2015-08-20 |
| 1770995219 | Divinity Healthcare Services Pllc | Preferred Provider Organization | 620 S Elder St, Nampa, ID 83686-5212 | 2014-06-02 |
| 1609113455 | Stone Ridge Dental P.C. | Preferred Provider Organization | 380 W Judicial St, Blackfoot, ID 83221-2122 | 2013-01-14 |
| 1558512277 | Stone Ridge Dental Inc. | Preferred Provider Organization | 1035 October Cv, Shelley, ID 83274-5068 | 2008-10-01 |
| 1629266424 | Victoria L Johnson | Preferred Provider Organization | 18168 Spicebush Ave, Nampa, ID 83687-5003 | 2007-10-05 |
| 1700890068 | Better Health & Play Therapy, Inc. | Preferred Provider Organization | 213 11th Ave S, Nampa, ID 83651-3920 | 2006-07-29 |
| 1235670704 | Douglas R. Schultz | Preferred Provider Organization | 859 S Yellowstone Hwy Ste 301, Rexburg, ID 83440-5321 | 2017-03-16 |
| 1043643844 | Burks Counseling, Pllc | Preferred Provider Organization | 1674 W Hill Rd, Suite 17, Boise, ID 83702-0958 | 2013-08-15 |
| Find all providers with the same taxonomy | ||||
| City | COEUR D ALENE |
| Zip Code | 83815 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.