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DONNELLY MEDICAL CLINIC
NPI 1902937196
Clinic/Center - Primary Care in Donnelly, ID

Active since March 08, 2007
454 ROSEBURY ROAD, SUITE 103, DONNELLY, ID 83615(208) 325-4455(208) 325-4466 Get Directions Write a Review

NPPES record last updated: March 17, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Donnelly Medical Clinic NPPES

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

DONNELLY MEDICAL CLINIC (NPI 1902937196) is a healthcare organization registered as a primary care in Donnelly, Idaho and active in the NPI registry since March 2007. The organization lists Jacqueline R Bruns, Vp - Physician Services, as its authorized official.

NPPES Registry Identity

NPI1902937196
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NamePAYETTE LAKES MEDICAL CLINIC, PA
Location Address454 ROSEBURY ROAD, SUITE 103Donnelly, ID 83615
Mailing AddressPo Box 1047Mccall, ID 83638-1047 · (208) 325-4455 · Fax (208) 325-4466
Phone(208) 325-4455
Fax(208) 325-4466
Organization SubpartNo
Authorized OfficialJacqueline R BrunsVp - Physician Services · (208) 634-4061
Enumeration DateMarch 8, 2007
Last NPPES UpdateMarch 17, 2008
✔ NPI 1902937196 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
454 ROSEBURY ROAD, Donnelly, ID 83615
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Other Names 1

Other NameDonnelly Medical Clinic

Other Identifiers 3

Other8N006ID · Bc
Medicare PIN1372681ID
Other000010160243ID · Bs

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 Payette Lakes Medical Clinic, PA's NPI number?

The NPI number for Payette Lakes Medical Clinic, PA is 1902937196. It was assigned to this organization in the NPPES registry on March 8, 2007. The provider is also known as Donnelly Medical Clinic.

Where is Payette Lakes Medical Clinic, PA located?

Payette Lakes Medical Clinic, PA is located at 454 Rosebury Road Suite 103, Donnelly, ID 83615. The listed phone number is (208) 325-4455.

What is Payette Lakes Medical Clinic, PA's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

When was this NPI record last updated?

The NPPES record for Payette Lakes Medical Clinic, PA was last updated on March 17, 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.