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Contact Information

MOUNTAIN PINE DERMATOLOGY, PLLC
1576 W DEER CREST ST
STE. #100
MERIDIAN, ID83646
 Phone: 208-898-7467
 Fax: 208-314-0102
 Website: http://mtnpinederm.com
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for MOUNTAIN PINE DERMATOLOGY, PLLC

NPI # 1659827665
LBN Legal business name MOUNTAIN PINE DERMATOLOGY, PLLC
Authorized official RICHARD THOMAS - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/30/2016
Last updated 07/05/2020 - About 6 years ago
Identifiers
ID License # O-0934
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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