NUTRITIONAL MEDICINE OF IDAHO; NPI #1467621383

Contact Information

NUTRITIONAL MEDICINE OF IDAHO

1520 W STATE ST
SUITE 220
BOISE, ID 83702-4085

Phone: 208-343-3883
Fax: 208-287-2010
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Nutrition, Education	133NN1002X

Indicates primary specialty

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NPI Profile & details for NUTRITIONAL MEDICINE OF IDAHO

NPI Number 1467621383

LBN Legal business name NUTRITIONAL MEDICINE OF IDAHO

Authorized official MATTHEW MACHA - (OWNER)

Entity Organization

Organization subpart ¹ No

Enumeration date 02/25/2008

Last updated 02/25/2008 - About 18 years ago

Identifiers

License #

D043

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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NUTRITIONAL MEDICINE OF IDAHO

Contact Information

Specialty

Nutrition, Education

NPI Profile & details for NUTRITIONAL MEDICINE OF IDAHO

Reviews for NUTRITIONAL MEDICINE OF IDAHO