REXBURG FAMILY MEDICAL CENTER, PLLC (NPI# 1285700377) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285700377 |
| Entity Type | Organization |
| Organization Name | REXBURG FAMILY MEDICAL CENTER, PLLC |
| Other Organization Name | FAMILY MEDICAL CENTER |
| Practice Address |
1 Professional Plz Rexburg ID 83440-2024 |
| Practice Telephone | 2083569231 |
| Practice Fax Number | 2083569141 |
| Mailing Telephone | 2083569231 |
| Mailing Fax Number | 2083569141 |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2010-09-20 |
| Authorized Official Name | DR. MICHAEL M PACKER (OWNER) |
| Authorized Official Telephone | 2083569231 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Family Medical Center | Doing Business As Name - Organization |
| Street Address |
1 PROFESSIONAL PLZ |
| City | REXBURG |
| State | ID |
| Zip Code | 83440-2024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962585752 | Travis J Weiszhaar | Physician Assistant | 1 Professional Plz, Rexburg, ID 83440-2024 | 2006-10-23 |
| 1497277412 | Blake Lee Galbraith | Physical Medicine & Rehabilitation | 1 Professional Plz, Rexburg, ID 83440-2024 | 2017-07-11 |
| 1427408210 | Kristi Neibaur | Physical Therapist | 1 Professional Plz, Rexburg, ID 83440-2024 | 2016-06-13 |
| 1902296189 | Neil Marion | Occupational Therapist | 1 Professional Plz, Rexburg, ID 83440-2024 | 2015-01-27 |
| 1518360692 | Justin Hammer | Physical Therapist | 1 Professional Plz, Rexburg, ID 83440-2024 | 2014-10-02 |
| 1093118184 | Clark Dabell | Physical Therapist | 1 Professional Plz, Rexburg, ID 83440-2024 | 2014-10-02 |
| 1356754147 | Advanced Physical Therapy & Wound Center, Pllc | Occupational Therapy Assistant | 1 Professional Plz, Rexburg, ID 83440-2024 | 2014-06-09 |
| 1679748248 | Alicia G Siddoway | Physical Therapist | 1 Professional Plz, Rexburg, ID 83440-2024 | 2008-04-24 |
| 1558445932 | Nichole Robson | Physician Assistant | 1 Professional Plz, Rexburg, ID 83440-2024 | 2006-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235768490 | Henry's Fork Surgery Center Pllc | Clinic/Center | 23 Sawtelle Ave, Rexburg, ID 83440 | 2020-04-08 |
| 1952956906 | Shane Ellis Withers | Pharmacist | 164 E. Main, Rexburg, ID 83440 | 2019-08-06 |
| 1316392285 | Emma Anderson | Speech-Language Pathologist | 36 Professional Plaza Suite 110, Rexburg, ID 83440 | 2016-04-28 |
| 1851755524 | Sandra Frickey | Speech-Language Pathologist | 1087 Summers Drive, Premier Therapy Associates, Rexburg, ID 83440 | 2016-04-08 |
| 1275997215 | Kerry Denney | Counselor | 333 Walker Drive, Rexburg, ID 83440 | 2016-04-06 |
| 1467837583 | Wal-mart Stores, Inc. | Technician/Technologist | 303 E Moody Rd, Rexburg, ID 83440 | 2015-07-30 |
| 1649692609 | Tanabell Health Services, Inc. | Skilled Nursing Facility | 410 W 1st N, Rexburg, ID 83440 | 2014-01-10 |
| 1043652571 | Creed Simon Webster | Counselor | 30 S 2nd W, Rexburg, ID 83440 | 2013-07-25 |
| 1033461660 | James Cannon Allen Dds PC | Dentist | 106 E 1st North, Rexburg, ID 83440 | 2012-10-05 |
| 1417217316 | Shelby Dee Woolstenhulme | Speech-Language Pathologist | 450 E. Main Street, Rexburg, ID 83440 | 2012-05-24 |
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| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346643038 | Madison Memorial Hospital | Clinic/Center | 450 E Main St, Rexburg, ID 83440-2048 | 2014-10-08 |
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| 1457983462 | Amh Series II Id, LLC | Clinic/Center | 3875 E Overland Rd Ste 1e, Meridian, ID 83642-9005 | 2020-02-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1447801451 | Mountain Country Family Healthcare, Pllc | Clinic/Center | 31911 N 5th Ave, Spirit Lake, ID 83869 | 2019-09-23 |
| 1275186835 | Bella Family Healthcare & Aesthetics | Clinic/Center | 1545 E Leighfield Dr Ste 100, Meridian, ID 83646-5371 | 2019-07-22 |
| 1902387285 | Integrative Health Solutions Pllc | Clinic/Center | 1215 Michigan St Ste B, Sandpoint, ID 83864-5014 | 2018-08-24 |
| 1235618331 | Healthworks Med Group of Colorado P C | Clinic/Center | 126 E 21st St, Burley, ID 83318-2551 | 2018-08-09 |
| 1427537927 | Gem State Family Health Care Pllc | Clinic/Center | 496 Shoup Ave W Ste E, Twin Falls, ID 83301-5043 | 2018-08-07 |
| 1700379682 | Vera Whole Health, Wa PC | Clinic/Center | 219 Phil Meador Ave, Pocatello, ID 83202 | 2018-06-14 |
| 1073031118 | Clover Creek Medical | Clinic/Center | 175 North Main Street, Bloomington, ID 83223-8322 | 2017-09-08 |
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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.