Healthcare Provider Details

I. General information

NPI: 1932018611
Provider Name (Legal Business Name): THE HEALTH CLINIC AT EAGLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 E WINDING CREEK DR STE 200
EAGLE ID
83616-7236
US

IV. Provider business mailing address

9201 W STATE ST STE 114
BOISE ID
83714-2527
US

V. Phone/Fax

Practice location:
  • Phone: 208-379-3709
  • Fax: 208-379-3614
Mailing address:
  • Phone: 208-379-3709
  • Fax: 208-379-3614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. TRENT MATTHEW DELONG
Title or Position: PHYSICIAN/MANAGING MEMBER
Credential: DO
Phone: 208-379-3709