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General NPI Number Information
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NPI Number | 1609245109
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIONS IDAHO PLLC
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 2857 S MERIDIAN RD 100
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City | MERIDIAN
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State | ID
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Zip | 83642-7960
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Country | US
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Telephone | 208-639-7300
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Fax | 208-287-8330
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Provider Business Mailing Address
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Address Line | 2857 S MERIDIAN RD 100
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City | MERIDIAN
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State | ID
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Zip | 83642-7960
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Country | US
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Telephone | 208-639-7300
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Fax | 208-287-8330
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JEFFREY R JACOMS
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Credential | MD
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Telephone | 208-639-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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