Healthcare Provider Details

I. General information

NPI: 1083338651
Provider Name (Legal Business Name): JUST 4 KIDS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 BOND AVE STE B
REXBURG ID
83440-3503
US

IV. Provider business mailing address

PO BOX 1407
IDAHO FALLS ID
83403-1407
US

V. Phone/Fax

Practice location:
  • Phone: 208-656-1500
  • Fax:
Mailing address:
  • Phone: 208-656-7396
  • Fax:

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. AARON GARDNER
Title or Position: PRESIDENT
Credential: MD
Phone: 208-656-7396