TABLE ROCK MOBILE MEDICINE PLLC NPI 1194186437

NPI Information

NPI: 1194186437
Provider Name: TABLE ROCK MOBILE MEDICINE PLLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
1111 S ORCHARD ST STE 251
BOISE, ID
ZIP 83705
Phone: (986) 224-8420
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TABLE ROCK MOBILE MEDICINE PLLC is a family nurse practitioner in Boise, ID. TABLE ROCK MOBILE MEDICINE PLLC NPI is 1194186437. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1111 S ORCHARD ST STE 251
BOISE, ID
ZIP 83705-964
Phone: (986) 224-8420
Fax: (208) 504-2821

The provider's authorized official is Bradley Bigford .
The authorized official title is Sole Member and has the following contact phone number (986) 224-8420.

The enumeration date for this NPI number is 3/15/2016 and was last updated on 9/2/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	NP-1252A	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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