Payette Lakes Medical Clinic, PA
Clinic/Center, Primary Care in Council, ID. Organization (NPI-2).
NPI number1881725331
StatusActive
Last updated in NPPESMar 17, 2008
Details
- NPI
- 1881725331
- Entity type
- Organization (NPI-2)
- Legal business name
- Payette Lakes Medical Clinic, PA
- Organization subpart
- Yes
- Enumeration date
- Mar 8, 2007
- Last updated
- Mar 17, 2008
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | – | – | Yes |
Other names
- Council Mountain Medical Clinic (Other Name)
Practice location
101 Council AvenueSuite C
Council, ID 83612
Phone 208-253-4915 · Fax 208-253-4917
Mailing address
Po Box 1047McCall, ID 83638-1047
Phone 208-634-2225 · Fax 208-634-7212
Authorized official
Jacqueline R Bruns
Vp - Physician Services
2086344061
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