Healthcare Provider Details

I. General information

NPI: 1629117767
Provider Name (Legal Business Name): INITIAL POINT FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 S EAGLE RD
MERIDIAN ID
83642-6704
US

IV. Provider business mailing address

2640 S EAGLE RD
MERIDIAN ID
83642-6704
US

V. Phone/Fax

Practice location:
  • Phone: 208-884-0835
  • Fax:
Mailing address:
  • Phone: 208-884-0835
  • Fax:

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PAUL V RYAN
Title or Position: PARTNER
Credential: MD
Phone: 208-870-6308