ADD CLINIC OF IDAHO; NPI #1801567029

Contact Information

ADD CLINIC OF IDAHO

1450 W USTICK RD
UNIT 102
MERIDIAN, ID 83646

Phone: 858-207-8861
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Family	363LF0000X	50	Nurse Practitioner

Indicates primary specialty

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NPI Profile & details for ADD CLINIC OF IDAHO

NPI Number	`1801567029`
LBN Legal business name	ADD CLINIC OF IDAHO
Authorized official	CODY MATTINGLY - (OWNER)
Entity	Organization
Organization subpart ¹	No
Enumeration date	09/27/2021
Last updated	09/27/2021 - About 5 years ago
Identifiers	n/a

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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