NORTH CANYON MOUNTAIN HOME CLINIC (NPI# 1649759374) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1649759374 |
Entity Type | Organization |
Organization Name | NORTH CANYON MOUNTAIN HOME CLINIC |
Practice Address |
840 N 4th E Mountain Home ID 83647-2166 |
Mailing Address |
267 N Canyon Dr Gooding ID 83330-5500 |
Practice Telephone | 2089348829 |
Practice Fax Number | 2089344874 |
Mailing Telephone | 2089344433 |
Enumeration Date | 2018-08-13 |
Last Update Date | 2018-08-13 |
Authorized Official Name | TIM POWERS (CEO) |
Authorized Official Telephone | 2089348765 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261Q00000X | Clinic/Center | ID | Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
ID | 1184932584 | 05 |
Street Address |
840 N 4TH E |
City | MOUNTAIN HOME |
State | ID |
Zip Code | 83647-2166 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1336784081 | Robin Amber Nettleton | Nurse Practitioner | 840 N 4th E, Mountain Home, ID 83647-2166 | 2019-11-16 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1528684370 | The Unruly Tongue Myofunctional Therapy LLC | Specialist | 1125 Nw Bluegrass Cir, Mountain Home, ID 83647 | 2020-06-17 |
1740767284 | Kelly Loy | Counselor | 210 North 3rd East, Mountain Home, ID 83647 | 2018-07-27 |
1891247912 | Daelene Sueann Tibbitts | Physical Therapy Assistant | 1665 E 5th N, Mountain Home, ID 83647 | 2016-10-25 |
1689065765 | Emma Orthel | Counselor | 2240 American Legion Blvd, Mountain Home, ID 83647 | 2015-02-11 |
1073692166 | Krzysztof Hendryk Ziola | Internal Medicine | 2280 American Legion Blvd., Mountain Home, ID 83647 | 2006-11-02 |
1952482440 | Michael Peter Koelsch | Internal Medicine | 805 North 6th East, Mountain Home, ID 83647 | 2006-10-18 |
1124113709 | Talmage W Delange | Counselor | 235 North 3rd East, Mountain Home, ID 83647 | 2006-10-03 |
1225044019 | Scott W Sessions | Physical Therapist | 245 N. 3rd, Mountain Home, ID 83647 | 2006-07-31 |
1750370730 | Kyle J Kenison | Optometrist | 855 West 6th South, Mountain Home, ID 83647 | 2005-10-21 |
1285628156 | Bruce Joseph Siedlecki | Obstetrics & Gynecology | Mtn.home Aif Force Base, Mdos, Mtn. Home, ID 83647 | 2005-09-07 |
Find all providers in zip 83647 |
Taxonomy Code | 261Q00000X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1992219190 | Legarde Chiropractic & Wellness, Pllc | Clinic/Center | 230 Highway 5 N Ste 30, Mountain Home, AR 72653-3030 | 2017-11-27 |
1801221189 | Foreman Family Chiropractic | Clinic/Center | 510 South College Street, Mountain Home, AR 72653-3274 | 2013-09-05 |
1437423472 | Baxter County Regional Hospital, Inc | Clinic/Center | 614 Broadmoor Dr, Mountain Home, AR 72653-2903 | 2012-03-07 |
1659555654 | Emile Victor Hamm | Clinic/Center | Corner of Lamont and Sydney Street Bldg 160, James H. Quillen Vamc, Mountain Home, TN 37684 | 2007-12-27 |
1023639614 | Vitality Plus LLC | Clinic/Center | 501 Hospital Dr, Mountain Home, AR 72653-2912 | 2020-05-05 |
1982167029 | Melissa Dirst-roberts Pllc | Clinic/Center | 860 Highway 62 E Ste 10, Mountain Home, AR 72653-3200 | 2019-04-06 |
1598030579 | Baxter County Regional Hospital Inc | Clinic/Center | 628 Hospital Dr, Suite E, Mountain Home, AR 72653-2953 | 2012-03-09 |
1295991917 | Joseph Long Dc Pa | Clinic/Center | 1 Medical Plz, Mountain Home, AR 72653-2918 | 2008-08-01 |
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1992323216 | Wolf Pack LLC | Clinic/Center | 939 S 25th E Ste 115, Ammon, ID 83406-5736 | 2020-07-13 |
1831730118 | Falls Medical Aesthetics, Pllc | Clinic/Center | 814 Pancheri Dr, Idaho Falls, ID 83402-3344 | 2019-10-08 |
1164072187 | Peter John Leichtnam | Clinic/Center | 1200 W Ironwood Dr Ste 309, Coeur D Alene, ID 83814-2660 | 2019-09-12 |
1124674437 | Michael J. Moorhouse Inc. | Clinic/Center | 13900 W Wainwright Dr Ste 100, Boise, ID 83713-5028 | 2019-08-13 |
1093368276 | Korena Popp Fnp Medical Services LLC | Clinic/Center | 454 W Roseberry Rd. Ste 104, Donnelly, ID 83615-8361 | 2019-07-17 |
1528623915 | D & S Works | Clinic/Center | 5622 W State St, Boise, ID 83703-3010 | 2019-05-01 |
1609335090 | Hurst Medical Pllc | Clinic/Center | 1700 Overland Ave Ste 1, Burley, ID 83318 | 2019-03-15 |
1912487646 | Ideal Option, Pllc | Clinic/Center | 509 W Hanley Ave Ste 101, Coeur D Alene, ID 83815-8994 | 2018-08-21 |
1801376256 | Ideal Option, Pllc | Clinic/Center | 1111 Blue Lakes Blvd N Ste E, Twin Falls, ID 83301-3437 | 2018-08-15 |
1104316785 | Pend Oreille Vision Care | Clinic/Center | 6132 Highway 2, Priest River, ID 83856 | 2018-05-18 |
Find all providers with the same taxonomy |
City | MOUNTAIN HOME |
Zip Code | 83647 |
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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.