MEDICARE: U.S. MEDGROUP OF IDAHO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1154267433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U.S. MEDGROUP OF IDAHO, LLC

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR STE 1200W
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-4624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5080 SPECTRUM DR STE 1200W
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-4624
Country	:	US
Telephone Number	:	888-352-6794
Fax Number	:	909-481-5318

Authorized Official
Title or Position	:	VP
Name	:	JOHN ANDERSON
Credential	:	DO
Telephone Number	:	972-364-8000

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	05/05/2026

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