# MERIDIAN PHYSICAL MEDICINE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1881144780
- **Authorized official:** MAKAYLA RUNYAN (VICE PRESIDENT)
- **Authorized official phone:** (208) 887-6810

## Contact information

- **Practice address:** 2016 S EAGLE RD, SUITE B, MERIDIAN, ID 83642-6707
- **Practice address phone:** (208) 887-6810
- **Practice address fax:** (208) 887-6797
- **Mailing address:** 2016 S EAGLE RD, SUITE B, MERIDIAN, ID 83642-6707
- **Mailing address phone:** (208) 887-6810
- **Mailing address fax:** (208) 887-6797

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | NP-1345A | ID | Yes |

## Other

- **Enumeration date:** 10/04/2016
- **Last updated:** 10/04/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1790053338 | NPI | ID |