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Organization
RIDGELINE MEDICAL LLC
Active
Organization
RIDGELINE MEDICAL LLC
Active
Other names
Ridgeline Medical LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN MANGAN DO (OWNER)
(208) 715-9990
Entity
Organization
Contact information
Practice address
2470 JAFER CT, IDAHO FALLS, ID 83404-5587
(208) 715-9990
(208) 715-9992
Mailing address
2429 JAFER CT, IDAHO FALLS, ID 83404-5587
(208) 715-9990
(208) 715-9992
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
NULL
111N00000X
Chiropractor
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QS1201X
Sleep Medicine (Family Medicine) Physician
—
NULL
207QS1201X
Sleep Medicine (Family Medicine) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
261QU0200X
Urgent Care Clinic/Center
—
NULL
Other
Enumeration date
10/22/2018
Last updated
11/01/2021
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