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Organization
MILESTONE MEDICAL LLC
Active
Organization
MILESTONE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JED ROBERTSON (CEO)
(208) 529-3342
Entity
Organization
Contact information
Practice address
1499 CURLEW DR, AMMON, ID 83406-4764
(208) 529-3342
(208) 529-6631
Mailing address
1499 CURLEW DR, AMMON, ID 83406-4764
(208) 529-3342
(208) 529-6631
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
08/19/2024
Last updated
08/20/2024
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