Healthcare Provider Details

I. General information

NPI: 1477086932
Provider Name (Legal Business Name): MEDICAL CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 E 36TH ST
GARDEN CITY ID
83714
US

IV. Provider business mailing address

9030 N HESS ST STE 474
HAYDEN ID
83835-9827
US

V. Phone/Fax

Practice location:
  • Phone: 208-514-0518
  • Fax: 208-493-8759
Mailing address:
  • Phone: 208-514-0518
  • Fax: 208-493-8759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberM4860
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberM4860
License Number StateID

VIII. Authorized Official

Name: JOHN CASPER
Title or Position: OWNER
Credential: MD
Phone: 208-514-0518