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General NPI Number Information
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NPI Number | 1215106695
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Entity Type | Organization
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Legal Business Name | RMHW MERIDIAN SOUTH LLC.
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 2985 S. MERIDIAN RD. STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-7088
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Country | US
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Telephone | 208-287-9444
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Fax | 208-287-6570
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Provider Business Mailing Address
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Address Line | 951 E. PLAZA DR. STE 110
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City | EAGLE
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State | ID
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Zip | 83616-6567
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Country | US
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Telephone | 208-938-5680
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Fax | 208-938-5679
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Authorized Official
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Title or Position | COO
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Name | ERIN J PRETTY WEASEL
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Credential |
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Telephone | 208-938-5680
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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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