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ISLAND PARK MEDICAL CLINIC
NPI 1407026560
Clinic/Center in Island Park, ID

Active since March 05, 2008CLIA 13D1043496 · Waiver
3765 HIGHWAY 20 S, ISLAND PARK, ID 83429(208) 558-7766 Get Directions Write a Review

NPPES record last updated: April 2, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Island Park Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ISLAND PARK MEDICAL CLINIC (NPI 1407026560) is a healthcare organization registered as a clinic/center in Island Park, Idaho and active in the NPI registry since March 2008. The organization holds a CLIA Waiver certificate valid through February 24, 2027 and lists Stephen Cheyne, President, as its authorized official.

NPPES Registry Identity

NPI1407026560
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameFREMONT MEDICAL SERVICES PC
Location Address3765 HIGHWAY 20 SIsland Park, ID 83429
Mailing AddressPo Box 826Ashton, ID 83420-0826
Phone(208) 558-7766
Organization SubpartYes
Authorized OfficialStephen CheynePresident · (208) 558-7766
Enumeration DateMarch 5, 2008
Last NPPES UpdateApril 2, 2008
✔ NPI 1407026560 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in ID · M4566
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
3765 HIGHWAY 20 S, Island Park, ID 83429
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Other Names 1

Other NameIsland Park Medical Clinic

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D1043496

Island Park Medical Clinic · Island Park, ID
Active · expires Feb 24, 2027
CLIA Number13D1043496
Laboratory TypeCommunity Clinic
Certificate Effective DateFebruary 25, 2025
Certificate Expiration DateFebruary 24, 2027
Laboratory DirectorMichael Packer
Laboratory Phone(208) 558-7766
Laboratory LocationIsland Park Medical Clinic3765 Hwy 20 South, Island Park, ID 83429
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fremont Medical Services PC's NPI number?

The NPI number for Fremont Medical Services PC is 1407026560. It was assigned to this organization in the NPPES registry on March 5, 2008. The provider is also known as Island Park Medical Clinic.

Where is Fremont Medical Services PC located?

Fremont Medical Services PC is located at 3765 Highway 20 S, Island Park, ID 83429. The listed phone number is (208) 558-7766.

What is Fremont Medical Services PC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Does Fremont Medical Services PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D1043496) is associated with this NPI, valid through February 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Fremont Medical Services PC was last updated on April 2, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.