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General NPI Number Information
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NPI Number | 1811514870
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Entity Type | Organization
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Legal Business Name | ASCEND LLC
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 2001 S WOODRUFF AVE STE 9
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6371
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Country | US
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Telephone | 208-419-3002
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Fax | 208-656-5652
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Provider Business Mailing Address
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Address Line | 2001 S WOODRUFF AVE STE 9
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6371
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Country | US
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Telephone | 208-419-3002
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Fax | 208-656-5652
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MATTHEW F LARSEN
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Credential | DO
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Telephone | 208-419-3002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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