OrganizationActive
Portneuf Nephrology Center
NPI 1164413753 · End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Pocatello, ID
Provider details
- NPI number
- 1164413753
- Entity type
- Organization
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Jan Jacobs, Accounts Receivable Manager(208) 367-3076
- License
- BM7847203 (ID)
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
2001 Bench Rd
Pocatello, ID 83201-2033
Phone: (208) 637-1090
Fax: (208) 637-1097
Approximate (ZIP-level) locationGet directions
Mailing address
5610 Gage St
Boise, ID 83706-1332
Registry dates
- Enumerated
- 2005-11-02
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.