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  7. NPI Record 1639126493

MERIDIAN CENTER
Complete NPI Record 1639126493
Skilled Nursing Facility in Meridian, ID

NPI Status: Active since May 27, 2006

Contact Information

1351 W PINE AVE
MERIDIAN, ID
ZIP 83642
Phone: (208) 888-7049
Fax: (208) 888-7246

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Middle Name
  26. Authorized Official Title or Position
  27. Authorized Official Telephone Number
  28. Healthcare Provider Taxonomy Code 1
  29. Provider License Number 1
  30. Provider License Number State Code 1
  31. Healthcare Provider Primary Taxonomy Switch 1
  32. Healthcare Provider Taxonomy Code 2
  33. Provider License Number 2
  34. Provider License Number State Code 2
  35. Healthcare Provider Primary Taxonomy Switch 2
  36. Other Provider Identifier 1
  37. Other Provider Identifier Type Code 1
  38. Other Provider Identifier State 1
  39. Other Provider Identifier 2
  40. Other Provider Identifier Type Code 2
  41. Other Provider Identifier State 2
  42. Other Provider Identifier Issuer 2
  43. Other Provider Identifier 3
  44. Other Provider Identifier Type Code 3
  45. Other Provider Identifier State 3
  46. Other Provider Identifier Issuer 3
  47. Other Provider Identifier 4
  48. Other Provider Identifier Type Code 4
  49. Other Provider Identifier State 4
  50. Other Provider Identifier Issuer 4
  51. Other Provider Identifier 5
  52. Other Provider Identifier Type Code 5
  53. Other Provider Identifier State 5
  54. Other Provider Identifier Issuer 5
  55. Other Provider Identifier 6
  56. Other Provider Identifier Type Code 6
  57. Other Provider Identifier State 6
  58. Other Provider Identifier Issuer 6
  59. Other Provider Identifier 7
  60. Other Provider Identifier Type Code 7
  61. Other Provider Identifier State 7
  62. Other Provider Identifier Issuer 7
  63. Other Provider Identifier 8
  64. Other Provider Identifier Type Code 8
  65. Other Provider Identifier State 8
  66. Other Provider Identifier Issuer 8
  67. Other Provider Identifier 9
  68. Other Provider Identifier Type Code 9
  69. Other Provider Identifier State 9
  70. Other Provider Identifier 10
  71. Other Provider Identifier Type Code 10
  72. Other Provider Identifier State 10
  73. Other Provider Identifier Issuer 10
  74. Other Provider Identifier 11
  75. Other Provider Identifier Type Code 11
  76. Other Provider Identifier State 11
  77. Other Provider Identifier Issuer 11
  78. Other Provider Identifier 12
  79. Other Provider Identifier Type Code 12
  80. Other Provider Identifier State 12
  81. Other Provider Identifier Issuer 12
  82. Other Provider Identifier 13
  83. Other Provider Identifier Type Code 13
  84. Other Provider Identifier State 13
  85. Other Provider Identifier Issuer 13
  86. Other Provider Identifier 14
  87. Other Provider Identifier Type Code 14
  88. Other Provider Identifier State 14
  89. Other Provider Identifier Issuer 14
  90. Other Provider Identifier 15
  91. Other Provider Identifier Type Code 15
  92. Other Provider Identifier State 15
  93. Other Provider Identifier Issuer 15
  94. Other Provider Identifier 16
  95. Other Provider Identifier Type Code 16
  96. Other Provider Identifier State 16
  97. Other Provider Identifier Issuer 16
  98. Other Provider Identifier 17
  99. Other Provider Identifier Type Code 17
  100. Other Provider Identifier State 17
  101. Other Provider Identifier Issuer 17
  102. Other Provider Identifier 18
  103. Other Provider Identifier Type Code 18
  104. Other Provider Identifier State 18
  105. Other Provider Identifier Issuer 18
  106. Other Provider Identifier 19
  107. Other Provider Identifier Type Code 19
  108. Other Provider Identifier State 19
  109. Other Provider Identifier Issuer 19
  110. Is Organization Subpart

Complete NPI Dataset

This page represents the complete record for NPI 1639126493. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1639126493
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: MERIDIAN CENTER
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 1351 W PINE AVE
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: MERIDIAN
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: ID
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 836425031
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 2088887049
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 2088887246
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1351 W PINE AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: MERIDIAN
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: ID
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 836425031
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 2088887049
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 2088887246
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/27/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/27/2017
The date that a record was last updated or changed.
Authorized Official Last Name: BERG
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: MICHAEL
The first name of the authorized official.
Authorized Official Middle Name: T.
The middle name of the authorized official.
Authorized Official Title or Position: ASSISTANT SECRETARY
The title or position of the authorized official.
Authorized Official Telephone Number: 5054684752
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 310400000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 75
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: ID
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 314000000X
Provider License Number 2: 75
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: ID
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: Y
Other Provider Identifier 1: 8041302
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: ID
Other Provider Identifier 2: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: ID
Other Provider Identifier Issuer 2: COLONIAL PENN
Other Provider Identifier 3: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: ID
Other Provider Identifier Issuer 3: AETNA LIFE INS
Other Provider Identifier 4: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: ID
Other Provider Identifier Issuer 4: AETNA US HEALTHCARE
Other Provider Identifier 5: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: ID
Other Provider Identifier Issuer 5: AMER PIONEER LIFE
Other Provider Identifier 6: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: ID
Other Provider Identifier Issuer 6: CIGNA
Other Provider Identifier 7: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: ID
Other Provider Identifier Issuer 7: BC/BS OF UTAH
Other Provider Identifier 8: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: ID
Other Provider Identifier Issuer 8: GLOBAL LIFE
Other Provider Identifier 9: 805698600
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 9: ID
Other Provider Identifier 10: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 10: ID
Other Provider Identifier Issuer 10: ALLSTATE INS
Other Provider Identifier 11: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 11: ID
Other Provider Identifier Issuer 11: AMER INCOME LIFE INS
Other Provider Identifier 12: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 12: ID
Other Provider Identifier Issuer 12: GREAT WEST LIFE
Other Provider Identifier 13: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 13: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 13: ID
Other Provider Identifier Issuer 13: CENTRAL STATES HEALTH & L
Other Provider Identifier 14: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 14: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 14: ID
Other Provider Identifier Issuer 14: ADMINISTRATORS WEST
Other Provider Identifier 15: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 15: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 15: ID
Other Provider Identifier Issuer 15: BOISE CASCADE CORP
Other Provider Identifier 16: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 16: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 16: ID
Other Provider Identifier Issuer 16: AFLAC
Other Provider Identifier 17: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 17: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 17: ID
Other Provider Identifier Issuer 17: ASSOC. FOR LUTHERANS
Other Provider Identifier 18: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 18: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 18: ID
Other Provider Identifier Issuer 18: AMER REPLUC INS
Other Provider Identifier 19: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 19: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 19: ID
Other Provider Identifier Issuer 19: ASSOC FOOD STORES
Is Organization Subpart: N