MEDICARE: KIRSCH WELLNESS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207P00000X	Emergency Medicine Physician
2	208D00000X	General Practice Physician
3	202D00000X	Integrative Medicine Physician

General Provider Information

NPI Number	:	1407553621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRSCH WELLNESS LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 384
Second Line	:
City	:	MIDDLETON
State	:	ID
Zip	:	83644
Country	:	US
Telephone Number	:	208-406-7780
Fax Number	:	208-939-3754

Provider Business Practice Location Address
First Line	:	742 E. STATE ST. STE 150
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616
Country	:	US
Telephone Number	:	208-939-3750
Fax Number	:	208-939-3754

Authorized Official
Title or Position	:	OWNER AND PROVIDER
Name	:	REBECCA M KIRSCH
Credential	:	D.O.
Telephone Number	:	208-406-7780

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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Directions to “KIRSCH WELLNESS LLC ” Practice Location

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