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General NPI Number Information
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NPI Number | 1225994437
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Entity Type | Organization
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Legal Business Name | PRESTIGE WORLDWIDE LPB LLC
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Dates
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Enumeration Date | 12/31/2025
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 20394 N SHEPHERDS PIE WAY
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City | BOISE
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State | ID
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Zip | 83714-1915
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Country | US
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Telephone | 208-999-0149
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Fax |
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Provider Business Mailing Address
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Address Line | 20394 N SHEPHERDS PIE WAY
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City | BOISE
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State | ID
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Zip | 83714-1915
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Country | US
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Telephone | 208-999-0149
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | LUCAS BELFORD
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Credential | PA
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Telephone | 208-999-0149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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