CENTER STREET HEALTH CARE LLC; NPI #1417104530

Contact Information

CENTER STREET HEALTH CARE LLC

1553 E CENTER ST
POCATELLO, ID 83201-4135

Phone: 208-233-9355
Fax: 208-233-9300
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Family	363LF0000X	50	Nurse Practitioner

Indicates primary specialty

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NPI Profile & details for CENTER STREET HEALTH CARE LLC

NPI # 1417104530

LBN Legal business name CENTER STREET HEALTH CARE LLC

Authorized official CYNTHIA RICE - (OWNER/PROVIDER)

Entity Organization

Organization subpart ¹ No

Enumeration date 08/20/2008

Last updated 09/30/2008 - About 18 years ago

Identifiers

ID	License #	NP252A
ID	Medicaid	004383300

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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CENTER STREET HEALTH CARE LLC

Contact Information

Specialty

Family

NPI Profile & details for CENTER STREET HEALTH CARE LLC

Reviews for CENTER STREET HEALTH CARE LLC