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General NPI Number Information
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NPI Number | 1932018611
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Entity Type | Organization
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Legal Business Name | THE HEALTH CLINIC AT EAGLE
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Dates
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Enumeration Date | 09/07/2026
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Last Update Date | 09/07/2026
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Provider Practice Location Address
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Address Line | 839 E WINDING CREEK DR STE 200
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City | EAGLE
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State | ID
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Zip | 83616-7236
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Country | US
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Telephone | 208-379-3709
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Fax | 208-379-3614
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Provider Business Mailing Address
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Address Line | 9201 W STATE ST STE 114
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City | BOISE
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State | ID
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Zip | 83714-2527
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Country | US
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Telephone | 208-379-3709
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Fax | 208-379-3614
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Authorized Official
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Title or Position | PHYSICIAN/MANAGING MEMBER
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Name | DR. TRENT MATTHEW DELONG
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Credential | DO
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Telephone | 208-379-3709
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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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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