COLLEEN SHACKELFORD, LLC
NPI 1689744963
Family Medicine in Boise, ID

Q: What is Center For Lifetime Health's NPI number?

The NPI number for Center For Lifetime Health is 1689744963. It was assigned to this organization in the NPPES registry on November 8, 2006. The provider is doing business as Colleen Shackelford, LLC.

Q: What is Center For Lifetime Health's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since November 08, 2006CLIA 13D1033411 · Microscopy

300 E BANNOCK ST, BOISE, ID 83712(208) 342-7400(208) 342-1879 Get Directions Write a Review

NPPES record last updated: July 25, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Colleen Shackelford, Llc NPPES

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

COLLEEN SHACKELFORD, LLC (NPI 1689744963) is a healthcare organization registered as a family medicine in Boise, Idaho and active in the NPI registry since November 2006. The organization holds a CLIA Microscopy certificate valid through November 8, 2026 and lists Colleen Shackelford, Owner, as its authorized official.

NPPES Registry Identity

NPI1689744963

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameCENTER FOR LIFETIME HEALTH

Location Address300 E BANNOCK STBoise, ID 83712

Mailing Address300 E Bannock StBoise, ID 83712 · (208) 342-7400 · Fax (208) 342-1879

Phone(208) 342-7400

Fax(208) 342-1879

Organization SubpartNo

Authorized OfficialColleen ShackelfordOwner · (208) 342-7400

Enumeration DateNovember 8, 2006

Last NPPES UpdateJuly 25, 2023

NPPES CertifiedJuly 25, 2023

✔ NPI 1689744963 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in ID · M5741

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

300 E BANNOCK ST, Boise, ID 83712

Open in Google Maps ↗

Other Names 1

Doing Business AsColleen Shackelford, Llc

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 for Provider-Performed Microscopy Procedures (PPMP) 13D1033411

Center For Lifetime Health · Boise, ID

Active · expires Nov 8, 2026

CLIA Number13D1033411

Laboratory TypePhysician Office

Certificate Effective DateNovember 9, 2024

Certificate Expiration DateNovember 8, 2026

Laboratory DirectorColleen Shackelford

Laboratory Phone(208) 342-7400

Laboratory LocationCenter For Lifetime Health111 W Main St Ste 100, Boise, ID 83702

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JOHN J ECK M.D.

Family Medicine