Organization
AGELESS WOMEN'S HEALTH ID LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TEAH PHILLIPS (CREDENTIALING MANAGER)
(901) 205-3999
Entity
Organization
Contact information
Practice address
3875 E OVERLAND RD STE 108, MERIDIAN, ID 83642-9047
(208) 268-5592
Mailing address
3875 E OVERLAND RD STE 108, MERIDIAN, ID 83642-9047
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
Other
Enumeration date
07/08/2024
Last updated
07/08/2024
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