Unknown Individual – Specialist, NPI 1790768455
Specialist
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Crestwood Drive, Meridian, Lauderdale County, Mississippi, 39302, United States
MERIDIAN, ID 836422800
Phone: (208) 887-1911
Fax: (208) 895-8049
Type: Mailing
1250, West Cherry Lane, Meridian, Ada County, Idaho, 83642, United States
MERIDIAN, ID 836421514
Phone: (208) 887-1911
Fax: (208) 895-8049
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 83642)
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