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General NPI Number Information
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NPI Number | 1881408003
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Entity Type | Organization
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Legal Business Name | RENEW MEDICAL GROUP OF IDAHO, PC
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 1717 ARLINGTON AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4802
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Country | US
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Telephone | 208-459-4641
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Fax |
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Provider Business Mailing Address
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Address Line | 700 E REDLANDS BLVD STE U302
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City | REDLANDS
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State | CA
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Zip | 92373-6109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARIN L RENTZ
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Credential | DO
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Telephone | 844-565-6471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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