1528173903 NPI number — MEDNOW INC

Table of content: (NPI 1528173903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528173903 NPI number — MEDNOW INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDNOW INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528173903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
323 E RIVERSIDE DR
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
EAGLE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83616-6864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-938-2136
Provider Business Mailing Address Fax Number:
208-938-2137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
323 E RIVERSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
EAGLE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83616-6864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-938-2136
Provider Business Practice Location Address Fax Number:
208-938-2137
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BECK
Authorized Official First Name:
BILL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
208-895-1957

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1123CP , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 1123CP , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 1123CP , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 1123CP , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000010013833 . This is a "REGENCE BS & HEALTH SENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002582900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 85233 . This is a "BLUE CROSS& TRUE BLUE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002583200 . This is a "MEDICAID PROFESSIONAL" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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