# MOMENTUM MEDICAL GROUP OF IDAHO LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417737594
- **Authorized official:** HEATHER BEARD (BILLING SERVICE)
- **Authorized official phone:** (208) 880-0883

## Contact information

- **Practice address:** 8854 W EMERALD ST STE 275, BOISE, ID 83704-4860
- **Practice address phone:** (208) 375-3201
- **Mailing address:** 8854 W EMERALD ST STE 140, BOISE, ID 83704-4845

## Taxonomy

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

## Other

- **Enumeration date:** 10/04/2023
- **Last updated:** 01/10/2024