| Align Integrated Medical Llc | |
|
750 W Ustick Rd Ste 100 Meridian ID 83646 | |
| (208) 639-1397 | |
| Not Available |
| Full Name | Align Integrated Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 750 W Ustick Rd Ste 100, Meridian, Idaho |
| Authorized Official Name and Position | Chad Woolner (CEO) |
| Authorized Official Contact | 2086391397 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Align Integrated Medical Llc 750 W Ustick Rd Ste 100 Meridian ID 83646-6133 Ph: (208) 639-1397 | Align Integrated Medical Llc 750 W Ustick Rd Ste 100 Meridian ID 83646 Ph: (208) 639-1397 |
| NPI Number | 1619484102 |
|---|---|
| Provider Enumeration Date | 01/05/2018 |
| Last Update Date | 07/07/2020 |
| Medicare PECOS PAC ID | 7315201993 |
|---|---|
| Medicare Enrollment ID | O20180507002508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619484102 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
| Provider Name | Russell C Allen |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1093730400 PECOS PAC ID: 3971401050 Enrollment ID: I20031229000173 |
| Provider Name | Brian Warren Moss |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1033384201 PECOS PAC ID: 3476624545 Enrollment ID: I20080617000457 |
| Provider Name | Nathan T Berrett |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1942505896 PECOS PAC ID: 2860677671 Enrollment ID: I20110420000771 |
| Provider Name | Robyn R Develle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215954862 PECOS PAC ID: 4880692052 Enrollment ID: I20131113002211 |
| Provider Name | Chad M Woolner |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1700027547 PECOS PAC ID: 8224251251 Enrollment ID: I20140520002674 |
| Provider Name | Kelly Hammerbeck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255881983 PECOS PAC ID: 0941580518 Enrollment ID: I20210201001390 |
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