MOUNTAIN STATES DIABETES RELIEF, LLC (NPI# 1144783499) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144783499 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN STATES DIABETES RELIEF, LLC |
| Practice Address |
4573 E Majestic Idaho Falls ID 83406 |
| Practice Telephone | 2085202636 |
| Mailing Telephone | 2085202636 |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2019-04-12 |
| Authorized Official Name | KATIE DAVENPORT (PARTNER) |
| Authorized Official Telephone | 2085202636 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians |
| Street Address |
4573 E MAJESTIC |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598383929 | Cristina Leon, Do Pa | Pediatrics | Idaho Falls Pediatrics, 3067 Eagle Dr, Ammon, ID 83406 | 2020-07-13 |
| 1447718853 | Root Cause Integrative Medicine LLC | Family Medicine | 1547 S Midway Ave, Suite B, Ammon, ID 83406 | 2019-03-05 |
| 1225379183 | Sterling Hospital LLC | General Acute Care Hospital | 5412 S. Rock House Cir, Idaho Falls, ID 83406 | 2013-03-01 |
| 1710236823 | Flower D. Aston | Dietitian, Registered | 300 Bridger Drive, Ammon, ID 83406 | 2012-09-05 |
| 1558658468 | Nathan Myers | Pharmacist | 1901 South 2500 East, Idaho Falls, ID 83406 | 2011-06-30 |
| 1760719934 | Snf Ammon Operating Company LLC. | Skilled Nursing Facility | 3909 South 25th East, Ammon, ID 83406 | 2009-11-10 |
| 1316192370 | A Childs Smile | Dentist | 3299 E. 17th Street, Ammon, ID 83406 | 2008-11-18 |
| 1992968804 | Brandon D Gordon | Dentist | 7186 Sage View Cr, Idaho Falls, ID 83406 | 2008-07-10 |
| 1891996526 | Help, Inc. | Community/Behavioral Health | 1465 Hoopes Ave, Idaho Falls, ID 83406 | 2007-05-30 |
| 1437294345 | Oliver Daniel Smith | Family Medicine | 3669 Ellendale Circle, Idaho Falls, ID 83406 | 2007-02-20 |
| Find all providers in zip 83406 | ||||
| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619977600 | John E Liljenquist | Internal Medicine | 2220 E 25th St, Idaho Falls, ID 83404-7542 | 2005-07-30 |
| 1437159423 | Carl D Vance | Internal Medicine | 3910 Washington Pkwy, Idaho Falls, ID 83404-7596 | 2005-07-30 |
| 1336220243 | Rocky Mountain Diabetes and Osteoporosis Center Pa | Internal Medicine | 3910 Washington Pkwy, Idaho Falls, ID 83404-7596 | 2006-10-18 |
| 1932109931 | David Redford Liljenquist | Internal Medicine | 2220 E 25th St, Idaho Falls, ID 83404-7542 | 2005-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679968051 | Michael Dee Holyoak | Internal Medicine | 520 S Eagle Rd Ste 1234, Meridian, ID 83642-6355 | 2015-04-01 |
| 1902143134 | Ennis Endocrinology, Pllc | Internal Medicine | 2450 E Gala St Ste 100, Meridian, ID 83642-4805 | 2013-01-08 |
| 1366647729 | Robert F. Ennis | Internal Medicine | 1626 Wells Ave, Suite 105, Meridian, ID 83642-4524 | 2007-06-18 |
| 1003881970 | Lynn Ge-zerbe | Internal Medicine | 1759 S Millenium Way, Meridian, ID 83642-1505 | 2006-02-22 |
| 1720068760 | Irinel N Stanciu | Internal Medicine | 403 S 11th St, Ste 100, Boise, ID 83702-6969 | 2006-01-17 |
| 1285142943 | Selkirk Endocrinology, Pllc | Internal Medicine | 1125 E Polston Ave Ste B, Post Falls, ID 83854-6045 | 2018-01-16 |
| 1801113329 | St Luke's Regional Medical Center | Internal Medicine | 403 S 11th St, Ste 100, Boise, ID 83702-6969 | 2010-04-23 |
| 1518165984 | Idaho Endocrinology, Pllc | Internal Medicine | 403 S 11th St, Suite 100, Boise, ID 83702-6968 | 2007-07-06 |
| 1659414399 | Richard B. Christensen, M.d. | Internal Medicine | 403 S 11th St, Suite 100, Boise, ID 83702-6968 | 2007-02-14 |
| 1255489746 | Gihan E. Dawood | Internal Medicine | 403 S 11th St, Suite 100, Boise, ID 83702-6969 | 2007-01-08 |
| Find all providers with the same taxonomy | ||||
| City | IDAHO FALLS |
| Zip Code | 83406 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.