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Organization
MERIDIAN PHYSICAL MEDICINE
Active
Organization
MERIDIAN PHYSICAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAKAYLA RUNYAN (VICE PRESIDENT)
(208) 887-6810
Entity
Organization
Contact information
Practice address
2016 S EAGLE RD, SUITE B, MERIDIAN, ID 83642-6707
(208) 887-6810
(208) 887-6797
Mailing address
2016 S EAGLE RD, SUITE B, MERIDIAN, ID 83642-6707
(208) 887-6810
(208) 887-6797
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-1345A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790053338
NPI
ID
Enumeration date
10/04/2016
Last updated
10/04/2016
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