Healthcare Provider Details

I. General information

NPI: 1669934220
Provider Name (Legal Business Name): THRIVE PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 N PENNGROVE WAY SUITE 210
MERIDIAN ID
83646
US

IV. Provider business mailing address

4740 N PENNGROVE WAY SUITE 210
MERIDIAN ID
83646
US

V. Phone/Fax

Practice location:
  • Phone: 208-514-0203
  • Fax: 855-818-2019
Mailing address:
  • Phone: 208-514-0203
  • Fax: 855-818-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON M TAYLOR
Title or Position: OWNER
Credential: D.O.
Phone: 208-789-6893