STATE OF IDAHO (NPI# 1790841781) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790841781 |
| Entity Type | Organization |
| Organization Name | STATE OF IDAHO |
| Other Organization Name | STATE HOSPITAL SOUTH LABORATORY |
| Practice Address |
700 East Alice Blackfoot ID 83221 |
| Mailing Address |
Box 400 700 East Alice Blackfoot ID 83221 |
| Practice Telephone | 2087858429 |
| Practice Fax Number | 2087858439 |
| Mailing Telephone | 2087858429 |
| Mailing Fax Number | 2087858439 |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | RALPH DUANE HECKARD (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2087858429 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | ID | Laboratories |
| Other Name | Type Code |
|---|---|
| State Hospital South Laboratory | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962755868 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1182 West Kyler Ave, Hayden, ID 83835 | 2012-10-17 |
| 1316063787 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-21 |
| 1750442315 | State of Idaho | Pharmacy | 700 East Alice Street, Blackfoot, ID 83221 | 2006-12-13 |
| 1801833454 | State of Idaho | Optometrist | 120 S Cole Rd, Suite 120 - Bldg 3, Boise, ID 83709-0932 | 2006-06-01 |
| 1649277393 | State of Idaho | Home Health | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2005-07-07 |
| 1790131027 | State of Idaho | Community/Behavioral Health | 1720 N Westgate Dr, Boise, ID 83704-7164 | 2016-05-05 |
| 1053615260 | State of Idaho | Psychologist | 700 E Alice St, Blackfoot, ID 83221-4925 | 2011-01-03 |
| 1538285481 | State of Idaho | Optometrist | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| 1588780449 | State of Idaho | Podiatrist | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| 1265558019 | State of Idaho | Family Medicine | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| Street Address |
700 EAST ALICE |
| City | BLACKFOOT |
| State | ID |
| Zip Code | 83221 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992789101 | State of Idaho Department of Health and Welfare | Psychiatric Hospital | 700 East Alice, Box 400, Blackfoot, ID 83221 | 2005-12-01 |
| 1609267715 | State of Idaho Department of Health and Welfare | Psychologist | 700 East Alice, Blackfoot, ID 83221 | 2015-02-11 |
| 1013132471 | Daniel Bart Harrison | Pharmacist | 700 East Alice, Blackfoot, ID 83221 | 2007-04-13 |
| 1790837292 | Chris C Lemon | Pharmacist | 700 East Alice, State Hospital South, Blackfoot, ID 83221-0400 | 2007-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932711165 | Samantha Paige Averett | Social Worker | 60 N Broadway, Blackfoot, ID 83221 | 2020-08-19 |
| 1730711656 | Sara Marie Letham | Family Medicine | 33 S Thompson Lane, Blackfoot, ID 83221 | 2020-02-08 |
| 1962994962 | Tyler Thomas Wood | Student in an Organized Health Care Education/Training Program | 98 Poplar Street, Blackfoot, Id 83221, Blackfoot, ID 83221 | 2018-06-05 |
| 1801336276 | Bmh, Inc. | Internal Medicine | 235 Poplar St, Blackfoot, ID 83221 | 2017-03-03 |
| 1497119804 | Susan Doran | Social Worker | 720 E. Alice, Blackfoot, ID 83221 | 2016-04-12 |
| 1427412121 | Josie Russell Adkins | Counselor | 720 East Alice, Blackfoot, ID 83221 | 2016-04-08 |
| 1740590314 | Ashley Nichole Thomas | Physician Assistant | 710 E. Alice Street, Blackfoot, ID 83221 | 2010-10-18 |
| 1528373313 | Stephanie Lynn Henderson | Dietitian, Registered | 1555 Vernon Ave, Blackfoot, ID 83221 | 2010-08-17 |
| 1184850141 | Joy H. Taylor | Nurse Practitioner | 1441 Parkway Drive, Blackfoot, ID 83221 | 2009-06-04 |
| 1427232925 | Nathan E. Sneddon | Anesthesiology | 98 Poplar St Fl 3, Blackfoot, ID 83221 | 2007-12-20 |
| Find all providers in zip 83221 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205195484 | Idaho Pathology Laboratory | Clinical Medical Laboratory | 98 Poplar St, Blackfoot, ID 83221-1758 | 2012-05-09 |
| 1699963397 | Blackfoot Medical Clinic Inc | Clinical Medical Laboratory | 1441 Parkway Dr, Blackfoot, ID 83221-1667 | 2007-10-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770183089 | Boise State University | Clinical Medical Laboratory | Bsu Science Bld Room 239 2133 W Cesar Chavez Ln, Boise, ID 83725-0001 | 2020-10-27 |
| 1730786328 | Idaho One Health Network, LLC | Clinical Medical Laboratory | 4455 S Meridian Rd, Meridian, ID 83642-6917 | 2020-10-06 |
| 1457984981 | Mini-cassia Misdemeanor | Clinical Medical Laboratory | 1359 Hansen Ave, Burley, ID 83318-1821 | 2020-02-12 |
| 1831743228 | Quest Diagnostics Clinical Laboratories Inc | Clinical Medical Laboratory | 215 E Hawaii Ave Ste B-100, Nampa, ID 83686-6011 | 2019-07-24 |
| 1801390521 | Local Lab LLC | Clinical Medical Laboratory | 8382 N Wayne Dr Ste 201, Hayden, ID 83835-6028 | 2018-03-19 |
| 1326553421 | The Local Lab, LLC | Clinical Medical Laboratory | 8382 N Wayne Dr Ste 103, Hayden, ID 83835-6028 | 2017-12-11 |
| 1457722092 | Bear Tooth Laboratory, LLC | Clinical Medical Laboratory | 1125 E Pine Ave, Ste B, Meridian, ID 83642-5955 | 2015-10-08 |
| 1730550377 | Landbank Laboratories, LLC | Clinical Medical Laboratory | 1020 Land Bank St, Suite B, Idaho Falls, ID 83402-1809 | 2015-10-08 |
| 1629486311 | Julia Anne Sanford Biggerstaff | Clinical Medical Laboratory | 4355 W Emerald St, Suite 140, Boise, ID 83706-2050 | 2014-07-26 |
| 1194150003 | Absolute Drug Testing, LLC | Clinical Medical Laboratory | 5433 N Government Way, Suite B, Coeur D Alene, ID 83815-9259 | 2013-09-10 |
| Find all providers with the same taxonomy | ||||
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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.