PAYETTE LAKES MEDICAL CLINIC, PA (NPI# 1881725331) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881725331 |
| Entity Type | Organization |
| Organization Name | PAYETTE LAKES MEDICAL CLINIC, PA |
| Other Organization Name | COUNCIL MOUNTAIN MEDICAL CLINIC |
| Practice Address |
101 Council Avenue Suite C Council ID 83612 |
| Mailing Address |
Po Box 1047 Mccall ID 83638-1047 |
| Practice Telephone | 2082534915 |
| Practice Fax Number | 2082534917 |
| Mailing Telephone | 2086342225 |
| Mailing Fax Number | 2086347212 |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2008-03-17 |
| Authorized Official Name | JACQUELINE R BRUNS (VP - PHYSICIAN SERVICES) |
| Authorized Official Telephone | 2086344061 |
| Is Organization Subpart | Y |
| Parent Organization Name | PAYETTE LAKES MEDICAL CLINIC, PA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BC | 8G122 | 01 |
| ID | BS | 000010139844 | 01 |
| Other Name | Type Code |
|---|---|
| Council Mountain Medical Clinic | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902937196 | Payette Lakes Medical Clinic, Pa | Clinic/Center | 454 Rosebury Road, Suite 103, Donnelly, ID 83615 | 2007-03-08 |
| 1922139468 | Payette Lakes Medical Clinic, Pa | Clinic/Center | 320 Virginia Avenue, New Meadows, ID 83654 | 2007-03-08 |
| 1255462263 | Payette Lakes Medical Clinic, Pa | Clinic/Center | 211 Forest Street, Mccall, ID 83638 | 2007-03-08 |
| Street Address |
101 COUNCIL AVENUE SUITE C |
| City | COUNCIL |
| State | ID |
| Zip Code | 83612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578865143 | Council School District No. 13 | Local Education Agency (LEA) | 101 E Bleeker Ave, Council, ID 83612 | 2010-12-02 |
| 1891007399 | Kristin S Hadley | Social Worker | 205 N Berkley Steet, Council, ID 83612 | 2010-07-13 |
| 1831373125 | Lisa H Shine | Social Worker | 205 North Berkley Ave, Council, ID 83612 | 2007-12-21 |
| 1346259777 | Mountains West Dental Pllc | Dentist | 502 N Dartmouth, Mountains West Dental Clinic Pllc, Council, ID 83612 | 2006-08-05 |
| 1114967098 | Kenneth Charles Prince | Dentist | 205 N Berkley Ave, Council, ID 83612 | 2006-06-07 |
| 1528550860 | Amy Louise Beam | Nurse Practitioner | 205 N Berkley St, Council, ID 83612 | 2018-06-01 |
| 1508226226 | Tawni Peterson | Registered Nurse | 205 N Berkley St, Council, ID 83612 | 2016-02-24 |
| 1013260827 | Council School District | Local Education Agency (LEA) | 101 E Bleeker Ave, Box 468, Council, ID 83612 | 2012-10-17 |
| 1386836310 | Stacie Marie Hettinga | Counselor | 205 N Berkley, Council, ID 83612 | 2007-08-14 |
| 1225187172 | Kara Lynn Dillon | Dental Hygienist | 205 N Berkley, Council, ID 83612 | 2007-01-09 |
| Find all providers in zip 83612 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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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.