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RIDGELINE MEDICAL LLC NPI 1386110963


NPI Information

NPI: 1386110963
Provider Name: RIDGELINE MEDICAL LLC

Doing Business As: RIDGELINE MEDICAL LLC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 13D2162276

Address:
2470 JAFER CT
IDAHO FALLS, ID
ZIP 83404
Phone: (208) 715-9990
Get Directions

RIDGELINE MEDICAL LLC is a family medicine in Idaho Falls, ID. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. RIDGELINE MEDICAL LLC NPI is 1386110963. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Ridgeline Medical Llc.

The provider's business location address is:

2470 JAFER CT
IDAHO FALLS, ID
ZIP 83404-587
Phone: (208) 715-9990
Fax: (208) 715-9992

The provider's authorized official is Martin Mangan .
The authorized official title is Owner and has the following contact phone number (208) 715-9990.

The CLIA number assigned to this NPI record is 13D2162276 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/22/2018 and was last updated on 11/1/2021.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1111N00000XChiropractorNo
2207QS1201XFamily MedicineSleep MedicineNo
3208100000XPhysical Medicine & RehabilitationNo
4261QU0200XClinic/CenterUrgent CareNo
5207Q00000XFamily MedicineYes

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: 4/28/2024

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