| Mountain States Diabetes Relief, Llc | |
|
4573 E Majestic Idaho Falls ID 83406 | |
| (208) 520-2636 | |
| Not Available |
| Full Name | Mountain States Diabetes Relief, Llc |
|---|---|
| Speciality | Internal Medicine - Endocrinology, Diabetes & Metabolism |
| Location | 4573 E Majestic, Idaho Falls, Idaho |
| Authorized Official Name and Position | Katie Davenport (PARTNER) |
| Authorized Official Contact | 2085202636 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain States Diabetes Relief, Llc 4573 E Majestic Idaho Falls ID 83406 Ph: (208) 520-2636 | Mountain States Diabetes Relief, Llc 4573 E Majestic Idaho Falls ID 83406 Ph: (208) 520-2636 |
| NPI Number | 1144783499 |
|---|---|
| Provider Enumeration Date | 04/12/2019 |
| Last Update Date | 04/12/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144783499 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
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