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Mountain Medical Physician Specialists of Idaho PC

Diagnostic Radiology Physician in Burley, ID · enumerated 2008 · authorized official Clark Davis, Ceo.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1053597237

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Registry record

Entity type Organization (Type 2)
Legal business name Mountain Medical Physician Specialists of Idaho PC
Practice address 1501 Hiland Ave, Burley, ID, 83318
Phone (801) 284-1755
Fax (801) 262-3897
Enumeration date Jan 17, 2008
Last updated in NPPES Nov 12, 2008

Taxonomy & classification

2085R0202X Diagnostic Radiology Physician Allopathic & Osteopathic Physicians · License C176456 (ID) Primary

Authorized official

Name Clark Davis
Title Ceo
Phone (801) 284-1705

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Who is the authorized official for Mountain Medical Physician Specialists of Idaho PC?
NPPES lists Clark Davis (Ceo) as the authorized official for this organization.
What is the NPI number for Mountain Medical Physician Specialists of Idaho PC?
The NPI for Mountain Medical Physician Specialists of Idaho PC is 1053597237, a Type 2 (organization) record in the CMS NPPES registry.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2008-11-12.