NPI age
19 years
Enumerated 2007-03-08
● Active Type 2 · Organization
Payette Lakes Medical Clinic, PA
Payette Lakes Medical Clinic, PA is 1 of 104 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Bruns
Vp - Physician Services
Last NPPES update
2008-03-17
Source: monthly bulk 2026-05
How this organization compares
Across 104 active clinic/center providers in Idaho.
NPI age
19 years
↑ 8 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2007 → 2026
2007-03Enumerated in NPPES
2007
2026
Where they practice
Primary practice location
454 Rosebury Road, Suite 103
Donnelly, ID 83615
Mailing address
Po Box 1047
McCall, ID 836381047
Authorized official
Jacqueline R Bruns
Vp - Physician Services
📞 2086344061
Specialties
-
Clinic/Center PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 8N006 | BC |
| 01 (ID) | 000010160243 | BS |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Donnelly Medical Clinic
Practice context
Single-site organization. Only one practice location on file.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.