# RIDGELINE MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ridgeline Medical LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386110963
- **Authorized official:** MARTIN MANGAN DO (OWNER)
- **Authorized official phone:** (208) 715-9990

## Contact information

- **Practice address:** 2470 JAFER CT, IDAHO FALLS, ID 83404-5587
- **Practice address phone:** (208) 715-9990
- **Practice address fax:** (208) 715-9992
- **Mailing address:** 2429 JAFER CT, IDAHO FALLS, ID 83404-5587
- **Mailing address phone:** (208) 715-9990
- **Mailing address fax:** (208) 715-9992

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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