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Contact Information

SOUTH PARK, INC.
415 S ARTHUR AVE
POCATELLO, ID83204-3303
 Phone: 208-233-6833
 Fax: 208-233-6842
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nursing Care

251J00000X
Indicates primary specialty

NPI Profile & details for SOUTH PARK, INC.

NPI Number 1194930768
LBN Legal business name SOUTH PARK, INC.
Authorized official RUSSELL MCCOY - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 05/14/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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