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General NPI Number Information
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NPI Number | 1093446718
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Entity Type | Organization
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Legal Business Name | PARAGOND LLC
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 3715 E OVERLAND RD STE 120
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City | MERIDIAN
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State | ID
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Zip | 83642-8301
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Country | US
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Telephone | 208-789-0220
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Fax | 208-789-0047
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Provider Business Mailing Address
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Address Line | 3715 E OVERLAND RD STE 120
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City | MERIDIAN
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State | ID
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Zip | 83642-8301
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Country | US
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Telephone | 87-890-2202
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Fax | 205-789-0047
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MEGAN LANE
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Credential | PA-C
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Telephone | 208-789-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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