Provider Demographics
NPI:1669612271
Name:5 PEPPERS INC.
Entity type:Organization
Organization Name:5 PEPPERS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEO
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PEPPERSACK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:208-498-1760
Mailing Address - Street 1:353 W IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2856
Mailing Address - Country:US
Mailing Address - Phone:208-498-1760
Mailing Address - Fax:208-498-1761
Practice Address - Street 1:217 W GEORGIA AVE STE 120
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6812
Practice Address - Country:US
Practice Address - Phone:208-498-1760
Practice Address - Fax:208-498-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP656A363LP0808X
IDLMSW-277061041C0700X
ID656A363LF0000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8083269Medicaid
ID806976700Medicaid