MEDICARE: FMI CENTER OF OPTIMAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	202D00000X	Integrative Medicine Physician

General Provider Information

NPI Number	:	1346091246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FMI CENTER OF OPTIMAL HEALTH

Provider Business Mailing Address
First Line	:	435 S EAGLE RD STE 100
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-6018
Country	:	US
Telephone Number	:	208-609-9130
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 S EAGLE RD STE 100
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-6018
Country	:	US
Telephone Number	:	208-609-9130
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SAMUEL WARREN
Credential	:
Telephone Number	:	208-385-7711

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/28/2024

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